RC 


REPORT  OF  THE  SPECIAL 
COMMISSIONER    ON 
THE  ALIEN  INSANE  IN  THE 
CIVIL  HOSPITALS  OF  NEW 
YORK  STATE 


REPORT 


ON  THE 


Alien  Insane  in  the  Civil  Hospitals 


OF 


NEW  YORK  STATE 


SUBMITTED  TO   HIS  EXCELLENCY,  HONORABLE  MARTIN'  H.  GLYNN, 

GOVERNOR  OF  THE  STATE  OF  NEW  YORK, 

JANUARY  23,  1914 


BY 

SPENCER   L.   DAWES,   M.D. 

Special  Commissioner  on  the  Alien  Insane 


LEWIS  R.  PARKER, 
CHARLES  A.  DOOLITTLE,  JR. 

Counsel 


ALBANY 

J.  B.  LYON  COMPANY.  PRINTERS 
1914 


7  A 


REPORT  ON  THE   ALIEN   INSANE   IN  THE  CIVIL 
HOSPITALS  OF  NEW  YORK  STATE 


To  ILis  Excellency,  Honorable  Mar  (in  11.  (jlynn,  Governor  of  Ike 
^lale  of  Xew  York: 

The  following  study,  made  by  direction  of  Hon.  John  A.  Dix, 
former  governor  of  the  State  of  New  York,  deals  with  one  im- 
portant part  of  the  general  problem  of  lessening  the  burden  of  in- 
sanity in  our  commonwealth,  namely,  the  problem  of  the  alien 
insane,  and  is  based  upon: 

1.  Public  hearings  at  the  State  hospitals  for  the  care  of  the 
insane. 

2.  Public  hearings  in  the  cities  of  Albany  and  New  York,  at 
which  hearings  were  examined  hospital  superintendents,   repre- 
sentatives of  charitable  organizations,  private  citizens,  the  chief 
examiner  of  the  Bureau  of  Deportation  and  his  assistants,   the 
representatives  of  the  various  steamship  companies  which  bring 
immigrants  to  this  country,  and  representatives  of  foreign  govern- 
ments. 

3.  Statistics  of  the  nativity  and  citizenship  of  every  patient  in 
our  State  hospitals  obtained  from  a  special  census  taken  September 
30,  1912. 

4.  Investigation  with  reference  to  the  following  topics: 

I.  Provision  for  and  cost  of  maintenance  of  the  insane  in  the 
State  of  New  York. 

II.  Increase   of   insane   patients   in   the    State   hospitals   com- 
pared with  increase  in  general  population. 

III.  Nativity  and  citizenship  of  the  insane  in  the  State  hos- 
pitals. 

IV.  Nativity,  parentage  and  citizenship  of  admissions  to  the 
State  hospitals. 

Y.  Nativity  and  parentage  of  the  insane  and  of  the  population 
in  New  York  State. 

VI.  Nativity,  parentage  and  insanity  in  New  York  State  and 
the  United  States. 


301866 


4:     ALIKN    INSANE  IN  CIVIL  HOSPITALS  OF  NEW  YORK  STATE 

VII.  Time  of  aliens  in  United  States  before  admission  to  the 
State  hospitals. 

Y  1 1 1 .   Cost  of  caring  for  the  alien  insane. 

IX.  Some  of  the  causes  of  existing  conditions. 

X.  Eugenic  effects. 

XI.  Attitude  of  other  states. 

XII.  Suggestions  received. 

This  commission  was  appointed  to  examine  into  the  questions 
relating  to  the  alien  insane  in  the  civil  hospitals  of  the  State  of 
New  York,  in  order  to  ascertain  existing  conditions,  the  causes 
thereof  and  to  suggest  remedies  therefor. 

While  these  problems  of  the  alien  insane  are  intimately  con- 
nected with  immigration  it  should  be  clearly  borne  in  mind  that 
the  general  subject  of  immigration  is  entirely  without  the  province 
of  this  investigation. 

The  great  benefits  which  this  country  has  derived  from  immi- 
gration, the  relation  of  immigration  to  social,  industrial,  econo- 
mic and  other  problems  and  to  phases  of  the  public  health  other 
than  the  prevalence  of  mental  diseases  and  kindred  topics  are  not 
embraced  within  the  scope  of  this  inquiry. 

The  results  of  the  investigation  of  the  above  mentioned  topics 
are  as  follows : 


I.    PROVISION  FOR  AND  COST  OF  MAINTENANCE  OF 
THE  INSANE  IN  THE  STATE  OF  NEW  YORK 

The  State  of  New  York  maintains  sixteen  hospitals  of  which 
fourteen,  .under  the  general  management  of  the  State  Hospital 
Commission,  are  devoted  exclusively  to  the  care  of  the  civil  in- 
sane and  two,  under  the  control  of  the  State  Superintendent  of 
Prisons,  to  the  care  of  the  criminal  insane. 

The  valuation  of  the  lands  and  buildings  of  the  civil  hospitals 
as  appraised  by  the  State  Comptroller  (Mohansic  excepted)  dur- 
ing the  years  1911-12  and  the  personal  property  of  these  institu- 
tions, as  estimated  by  the  several  superintendents  in  their  reports 
of  September  30,  1912,  together  with  the  number  of  patients 
under  treatment  on  September  30,  1912,  arc  shown  in  the  follow- 
ing tables. 


REPORT  OF  SPECIAL  COMMISSIOXKK 
Civil  Hospitals 


STATE  HOSPITAL 

Number  of 
patients 

Value  of 
real  estate 

Value  of 
personal 
property 

Utica 

1,573 

$1,663,300 

$166,  000 

Willard 

2,381 

2,166,900 

220,000 

Hudson  River                                  

3,087 

3,253,425 

418,855 

Midclletown                     .    .    .        

2,020 

1,682,300 

135,000 

Buffalo                          

2,025 

3,030,100 

120,000 

Binghamton             

2,327 

2,675,956 

300,000 

St  Lawrence 

1,988 

2,910,000 

159,710 

Rochester 

1,498 

913,700 

55,985 

Gowanda 

1,104 

983,250 

165,500- 

]VIohansic 

51 

*169,155 

33,937 

Kings  Park                                  .        ... 

3,815 

3,423,900 

282,260 

Long  Island                   

747 

698,500 

85,000 

Manhattan                    

4,570 

4,446,150 

340,660 

Central  Islip  

4,438 

3,077,905 

204,002 

Total  

31,624 

$31,094,541 

$2,686,909 

*  As  estimated  by  superintendent. 

During  the  period  from  1900  to  1912  the  expenditures  for 
additions  and  betterments  to  the  various  civil  hospitals  and'  for 
the  maintenance  of  the  insane  were  as  follows : 

Expenditures  of  the  Fourteen  Civil  Hospitals,  1900-1912 


YEAR 

For 
maintenance 

For  new 
buildings, 
additional  land,, 
improvements, 
etc. 

1900      . 

$3,766,615  49 

$612,014  72 

1901 

3,558,407  84 

819,389  81 

1902 

3,722,346  55 

807,431  87 

1903 

4,104,689  23 

631,945  17 

1904    .  .                                                            

4,402,380  32 

670,651  19 

1905  ...             .                  .           

4,593,477  63 

838,500  50 

1906  

4,769,343  68 

793,877  84 

1907  

4,948,809  72 

917,994  32 

1908  

5,100,890  11 

803,761  44 

1909 

5,509,764  13 

992,753  62 

1910 

5,659,942  76 

1,320,658  95 

1911.. 

5,718,618  43 

1,114,366  87 

1912  

6,240,882  01 

955,887  56 

G     ALIK.N    LXSAXK  ix  CIVIL  HOSPITALS  OF  XKNV  Yoinc  STATI-: 


40.000 


30.000 


22.088 

$4.378.630 

20,000 


10,000 


Chart  A 

INCREASE  OF  INSANE  PATIENTS  IN  THE  CIVIL  STATE  HOSPITALS 
COMPARED  WITH  INCREASE  OF  EXPENDITURES 
1900-1912 

/ 
/ 

/ 

/ 

s 
/ 

"-- 

s 

_-  —  — 

—  ^"^"! 

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^s' 

s 

s 
/ 

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Patie 

nts  in  th 
iditures 

:  Civil  S 
>f  the  Ci 

ate  Hos 

vil  State 

titals 
H«pit» 

— 

.     Expe 

1901 

1902 

1903 

1904 

1905 

1906 

1907 

1908 

1909 

1910 

1911 

1912 

$8.000.000 
$7.196.770 

3 1.624  Patient* 
$6.000.000 


$4.000.000  r= 


$2.000.000  JS 


Years 


T  OF  SPECIAL  COMMISSIONKK  7 

During  the  year  ending  September  30,  1912,  alone,  the  cost  to 
the  State  of  ISTew  York  for  actual  maintenance  of  the  patients  in 
its  fourteen  civil  hospitals  was  $6,240,882.01 ;  for  new  buildings, 
additional  lands,  repairs,  improvements,  etc.,  $955,887.56,  and  for 
general  administration,  including  inspection,  deportation  of  aliens 
and  scientific  research,  $163,766.86,  making  the  huge  total  of 
$7,360,536.43. 

The  enormous  increase  in  annual  expenditures  shown  in  detail 
in  the  foregoing  table  was  necessitated  not  alone  by  reason  of  the 
gradual  rise  in  the  cost  of  attendance  and  provisions  in  recent 
years,  but  also  because  the  insane  cared  for  in  the  State  hospitals 
have  increased. 


II.  INCREASE  OF  INSANE  PATIENTS  IN  THE  STATE 
HOSPITALS  COMPARED  WITH  INCREASE  IN  GEN- 
ERAL POPULATION 


The  total  population  of  the  State  of  Xew  York,  as  given  by  the 
Federal  Census  Bureau  was: 
In  1890-      6,003,174 

In  1900-      7,268,894  ..........  Per  cent  of  increase  21.1 

In  1910-      9,113,614  ..........  Per  cent  of  increase  25.4 

In  1912  —  *9,592,25S  ..........  Per  cent  of  increase  5.3 

Total   (1890-1912).  .  .Per  cent  of  increase  59.8 

The  insane  in  civil  hospitals  of  Kew  York  State  for  the  same 
period  were: 

In  1890  —  14,952 

In  1900  —  22,088  ......  Per  cent  of  increase  of  insane  47.7 

In  1910  —  30,445  ......  Per  cent  of  increase  of  insane  37.8 

In  1912  —  31,624.  ....  .Per  cent  of  increase  of  insane  3.9 

Total  .......  Per  cent  of  increase  of  insane  111.5 

Chart  B  shows  the  foregoing  graphically. 

The  insane  cared  for  in  the  civil  hospitals  have  increased  pro- 
portionately much  more  rapidly  than  has  the  general  population 
of  the  State.  This  is  readily  apparent  from  the  foregoing  com- 
parisons. 

*  Estimated. 


^      ALIKN    IN  SANK  IN   CIVIL   HOSPITALS  OF   NK\V   YOUR 

it      7*      ^D  <O  ^  r"~^  C5  ^ 

«w      5     r3  S*  ^  ^ 


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OF  SPECIAL  CoMMissiOKEB  9 

Taking  the  whole  period  from  1890  to  1U12  into  consideration, 
we  find  that  the  increase  in  insane  population  in  the  hospitals  was 
111.5  per  cent,  compared  with  59.8  per  cent  in  the  general  popu- 
lation of  the  State  of  New  York.  The  State  census  of  1905  gave 
the  population  of  the  State  as  8,067,308.  The  insane  patients  in 
the  civil  State  hospitals  in  the  same  year  numbered  25,518.  Com- 
paring these  numbers  with  those  for  1912,  we  find  that  the  in- 
crease in  general  population  has  been  18.9  per  cent,  and  in  insane 
population,  23.9  per  cent. 

The  ratio  of  insane  in  the  civil  hospitals  of  New  York  State 
to  the  population  of  the  State  shows  that 

In  1890  there  were  249  insane  for  each  100,000  of  population. 

In  1900  there  were  304  insane  for  each  100,000  of  population. 

In  1910  there  were  334  insane  for  each  100,000  of  population. 

In  1912  (estimated)  329.7  insane  for  each  100,000  of  popula- 
tion. 

If  we  include  in  the  calculation  all  the  insane  in  New  York 
State  in  State  hospitals  and  private  institutions  together  with  the 
criminal  insane  we  have  the  following: 

In  1890  there  were  266.6  insane  for  each  100,000  of  popula- 
tion. 

In  1900  there  were  327.1  insane  for  each  100,000  .of  popula- 
tion. 

In  1910  there  were  358.3  insane  for  each  100,000  of  popula- 
tion. 

In  1912  (estimated)  354.2  insane  for  each  100,000  of  popula- 
tion. 

It  is  however  but  fair  to  state  that  it  is  believed  that  a  more 
stable  ratio  of  the  insane  to  the  population  is  becoming  general 
as  decreases  in  ratio  have  been  observed  in  several  states  while  in 
others  for  a  number  of  years  the  increase  has  become  much  less 
marked. 

On  September  30,  1913,  the  total  number  of  insane  in  the  New 
York  civil  hospitals  was  32,599,  which  was  975  more  than  the 
total  hospital  population  of  (September  30,  1912.  The  per  cent 
of  increase  from  1910  to  1912  was  3.9;  the  per  cent  of  increase 
from  1912  to  1913  was  3.08. 

This  ratio  of  increase  of  the  insane  in  the  State  hospitals,  since 


10     ALIK.X    IXSAXK  i.\   CIVIL  HOSPITALS  OF  XE\V   YORK  STATE 


1905,  and  particularly  in  1012,  has  doubtless  been  largely  de- 
creased by  the  activity  of  the  State  Board  of  Alienists  (now  the 
Bureau  of  Deportation  under  the  State  Hospital  Commission)  in 
deporting  and  repatriating  the  alien  insane  and  in  returning  to 
their  homes  in  other  states  the  nonresident  insane. 

The  following  table  shows  the  work  of  this  board  since  1904: 

Number  of  Aliens  Deported  and  Repatriated  and  Nonresidents 
Returned,  1905-1912 


1905 

1906 

1907 

1908 

1909 

1910 

1911 

1912 

Total 

-4  liens  returned  to  other  coun- 
tries: 
Deported  by  the  U.  S.  immi- 
gration service  
Repatriated  at  the  expense  of 
State 

112 
2 

149 
6 

222 
20 

284 
25 

394 
30 

399 
95 

345 
204 

419 
474 

2,324 
856 

Repatriated  at  the  expense  of 
friends 

16 

14 

28 

64 

65 

119 

235 

278 

819 

Total    . 

130 

169 

270 

373 

489 

613 

784 

1  171 

3  999 

Nonresidents    returned    to 
other  Stales: 
At  expense  of  State 

28 

5 

23 

36 

40 

85 

151 

295 

663 

At  expense  of  friends  

12 

18 

29 

60 

46 

166 

191 

287 

809 

Total  

40 

23 

52 

96 

86 

251 

342 

582 

1,472 

Total  aliens  deported  and  re- 
patriated and     nonresidents 
returned  

170 

192 

322 

469 

575 

864 

1,126 

1,753 

5,471 

Thus  through  the  work  of  the  State  Board  of  Alienists  during 
the  years  from  1905  to  1912,  3,999  insane  aliens  were  deported 
or  repatriated  to  other  countries  and  1,472  insane  nonresidents 
returned  to  their  homes  in  other  states;  a  total  of  5,471  insane 
persons  removed  from  the  State.  In.  addition  to  these  during  the 
years  1905—08,  inclusive,  the  State  Commission  in  Lunacy 
(now  the  State  Hospital  Commission),  removed  from  the  State  a 
number  of  aliens  and  nonresidents,  directly  through  the  individual 
hospitals  without  the  aid  of  the  State  Board  of  Alienists,  as 
follows : 


1905 

1906 

1907 

1908 

Total 

Aliens 

169 

138 

82 

51 

440 

Nonresidents  

-78 

75 

118 

78 

349 

Total 

247 

213 

200 

129 

789 

REPORT  OF  SPECIAL  COMMISSIONED  11 

Combining  these  totals  with  those  of  the  State  Board  of  Alien- 
ists we  have  a  grand  total  for  the  years  1905-12,  inclusive,  of 
4,439  aliens  deported  and  repatriated  and  1,821  nonresidents  re- 
turned, making  altogether  6,260  insane  persons  removed  from  the 
State. 

Chart  C  is  a  graphic  representation  of  the  yearly  increase  in 
aliens  removed  together  with  the  resultant  saving  to  the  State. 
(See  also  page  44.) 

For  the  year  ending  September  30,  1913,  the  work  of  the 
Bureau  of  Deportation  was  as  follows : 

Aliens  returned  to  other  countries 
Deported  by  the  U.  S.  immigration  service 379 

(A  decrease  of  40  from  1912.) 
Repatriated  at  the  expense  of  State 292 

(A  decrease  of  182  from  1912.) 
Repatriated  at  the  expense  of  friends 194 

(A  decrease  of  84  from  1912.) 

865 

Nonresidents  returned  to  other  states 
At  expense  of  State 168 

(A  decrease  of  127  from  1912.) 
At  expense  of  friends 310 

(An  increase  of  32  over  1912.) 

487 

Total  aliens  deported  and  repatriated  and 

nonresidents  returned    1,352 

(A  decrease  of  401  from  1912.) 


It  is  apparent  from  the  foregoing  that  the  Bureau  of  Deporta- 
tion sent  from  this  State  306  less  aliens  in  1913  than  in  1912,  of 
which  the  chief  loss,  266,  was  in  the  repatriates,  and  returned  to 
other  states  95  less  nonresidents,  a  total  of  401,  or  22.8  per  cent 
less  in  1913  than  in  1912. 

Of  the  1913  total  of  1,352  aliens  and  nonresidents  986  had 
already  become  public  charges  in  the  various  State  hospitals, 
while  the  remaining  366  were  removed  from  the  psychopathic 


12     ALIEX  INSANE  IN  CIVIL  HOSPITALS  OF  NEW  YORK  STATE 


Insane 
Aliens 
Deported 

1200 

Chart  C 
INSANE  ALIENS  DEPORTED  BY  STATE  HOSPITAL  COMMISSION 
WITH  ECONOMIC  SAVINGS  EFFECTED.  1904  TO  1912 

Amount  saved 
the  State 
in  net  cost 

$2.651.208 

$2,209.340 
$1.777.472 

$1.325.604 
$883.736 
$441.868 

JOOO 

1 

$00 

1 

400 

/ 

-400 

^s 

^ 

/ 

200 
0 

/ 

—          — 

^ 

/ 

1904     1905     1906    1907    1908     1909     1910     1911     1912 


REPOKT  OF  SPECIAL  COMMISSIONER  ISP 

wards  of  Eellevue  and  Kings  County  hospitals  and  from  various- 
charitable  institutions. 

Of  the  379  aliens  deported  in  1013  by  the  U.  S.  Immigration 
Service,  334  had  actually  become  inmates  of  State  hospitals,  while 
the  remaining  45  had  been  or  were  public  charges  at  the  time  of 
their  deportation  in  institutions  supported  in  whole  or  in  part 
by  charity. 

In  1912  the  Bureau  of  Deportation  issued  medical  certificates 
for  the  deportation  of  511  aliens  who  had  become  public  charges 
by  reason  of  insanity  from  causes  which  existed  prior  to  and  at 
the  time  of  their  landing  in  this  country,  while  in  1913  the  num- 
ber of  medical  certificates  issued  was  461,  a  loss  of  51,  or  10  per 
cent  in  1913. 

The  Bureau  of  Deportation  states  that  several  factors  are  re- 
sponsible for  the  decrease  in  the  number  of  aliens  repatriated  by 
~New  York  State  in  1913  and  gives  as  the  most  important  reason 
the  fact  that  for  one  entire  month  it  was  impossible  to  obtain  any 
funds  for  repatriation  and  that  there  was  considerable  difiiculty 
in  obtaining  funds  for  this  purpose  during  two  other  months  of 
the  year. 


III.     "NATIVITY  AND  CITIZENSHIP  OF  THE  INSANE 
IN  THE  STATE  HOSPITALS 

(See  Table  1,  p.  86) 

In  order  to  ascertain  as  definitely  as  possible  the  character  of 
the  insane  population  in  the  State  hospitals  with  respect  to  na- 
tivity and  citizenship,  the  following  census  was  taken  by  the 
superintendents  on  September  30,  1912. 

Insane  in  our  civil  hospitals  on  September  30,  1912,  divided  as 
to  nativity: 

Xative-born,   17,896;  per  cent,   56.6. 
Foreign-born,  13,728 ;  per  cent,  43.4. 

Of  the  foreign-born  9,241,  or  29.2  per  cent  of  the  total  hospi- 
tal population  of  31,624,  were  aliens. 


*  The  statistics  of  this  report  were  prepared  under  the  supervision  of  Dr. 
Horatio  M.  Pollock,  the  statistician  of  the  New  York  State  Hospital  Com- 
mission. For  his  efficient  services  this  commission  is  very  greatly  indebted. 


14     ALIEN  INSANE  IN  CIVIL  HOSPITALS  or  £\"EW  YORK  STATE 

Of  the  foreign-born  patients,  it  was  found  that  4,487  had  been 
naturalized.  No  evidence  of  the  naturalization  of  the  remaining 
9,241  foreign-born  patients  was  found,  and  these,  because  of  their 
nativity,  were  necessarily  classed  as  aliens. 

The  "  unascertained,'7  wherever  mentioned  in  this  report,  are 
probably  of  foreign  birth  and  should  be  considered  aliens. 

Until  recent  years  the  hospitals  paid  relatively  little  attention, 
at  the  time  of  admission,  to  the  citizenship  of  the  patients  and 
consequently  the  records  of  some  of  the  older  cases  in  the  hospi- 
tals are  incomplete  in  this  respect. 

The  results  of  the  census,  however,  while  not  altogether  satis- 
factory, undoubtedly  give  a  fairly  correct  view  of  the  status  of 
the  patient  population. 

The  two  metropolitan  hospitals,  Manhattan  and  Central  Islip, 
which  receive  their  patients  mainly  from  Bellevue  hospital,  New 
York  City,  naturally  have  the  largest  number  of  alien  patients. 
In  1912  in  Manhattan  State  Hospital,  out  of  a  total  of  4,570  pa- 
tients only  2,044  were  native-born,  and  of  the  2,526  foreign-born 
patients  only  708  were  naturalized.  At  the  same  time  in  Central 
Islip  1,635  of  the  4,438  patients  were  native-born,  and  891  of 
the  2,803  foreign-born  patients  were  naturalized.  The  aliens  in 
Manhattan  State  Hospital  constituted  39.8  per  cent  of  the  popula- 
tion, and  in  Central  Islip  43.1  per  cent. 

The  percentage  of  aliens  in  the  up-State  hospitals  at  this  time 
ranged  from  12.3  per  cent  in  Utica  to  28.7  per  cent  in  Buffalo. 
Long  Island  State  Hospital  reports  the  second  lowest  percentage 
of  aliens,  namely  14.6  per  cent. 

Comparing  the  nativity  of  the  sexes,  we  find  in  Table  1  that 
the  foreign-born  constituted  39  per  cent  of  the  males  in  the  State 
hospitals  and  47.3  per  cent  of  the  females.  This  is  due  in  part 
to  the  fact  that  mortality  of  the  females  in  the  hospitals  is  less 
than  that  of  the  males,  and  to  the  further  fact  that  the  Bureau  of 
Deportation  has  deported  more  males  than  females.  A  like  differ- 
ence is  noted  in  the  citizenship  of  the  two  sexes,  24.4  per  cent  of 
the  males  being  aliens  and  33.4  per  cent  of  the  females. 


OF  SPECIAL  COMMISSIONED  15 


IV.     NATIVITY,   PARENTAGE   AND    CITIZENSHIP    OF 
ADMISSIONS  TO  THE  STATE  HOSPITALS 

For  the  purpose  of  ascertaining  definitely  the  nativity,  parent- 
age and  citizenship  of  the  patients  admitted  to  the  civil  State 
hospitals  during  the  past  eight  years,  a  blank  card  was  prepared 
calling  for  specific  information  concerning  each  patient  admitted, 
as  follows: 

Nativity  and  Citizenship 

State  Hospital 

MALE 
FIRST  ADMISSION 

Name Identification  No 

NATIVITY    (country  of  birth)    of  patient    

NATIVITY   (country  of  birth)   of  father 

NATIVITY    (country  of  birth)    of  mother     

CITIZENSHIP  OF  PATIENT  American  Foreign 

IF  NATURALIZED,  HOW  ?       By  final  papers       By  naturalization  of  parents 

CITIZENSHIP  OF  FATHER  American  Foreign 

IF  NATURALIZED,  HOW?     By  final  papers        By  naturalization  of  parents 

W7AS  FATHER  A  CITIZEN  AT  TIME  OF  BIRTH  OF  PATIENT?    

TIME  OF  PATIENT  IN  U.  S.  BEFORE  ADMISSION   Yrs Mos. 

TOTAL  TIME  OF  PATIENT  IN  STATE 

HOSPITALS   FOR   INSANE Yrs Mos. 

DATE  OF  ADMISSION   19 .... 

To  insure  the  separation  of  males  from  females  and  of  first  ad- 
missions from  readmissions,  the  male  cards  were  printed  in  black 
and  the  female  in  red,  the  first  admission  cards  o<n  white  board 
and  the  readmission  on  salmon.  A  supply  of  these  cards,  to- 
gether with  a  leaflet  of  explicit  instructions,  was  forwarded  to 
the  superintendent  of  each  hospital.  After  the  cards  were  filled 
out  from  the  records  of  the  hospitals  they  were  forwarded  to  the 
statistician  of  the  State  Hospital  Commission  for  tabulation. 
The  data  compiled  from  these  cards  are  set  forth  in  Tables  2—16. 

The  new  statistics  show  slight  differences  from  those  heretofore 
compiled  by  the  New  York  State  Hospital  Commission,  but  the 
discrepancies  are  not  important.  The  total  of  all  admissions  (in- 


16     ALIEN  INSANE  IN  CIVIL  HOSPITALS  OF  NEW  YORK  STATE 

eluding1  readmissioiis)  to  the  hospitals  from  1905  to  1912,  shows  a 
difference  of  28,  the  new  statistics  giving  the  number  as  52,158 
patients  as  against  52,182  patients  in  the  old. 

The  discrepancies  doubtless  arose  in  preparing  the  new  statisti- 
cal cards  from  the  individual  histories  at  the  State  hospitals, 
exact  distinction  not  being  made  in  every  instance  between  first 
admissions  and  readmissions  —  a  difficult  matter  in  some  cases  — 
and  as  to  patients  transferred  from  one  hospital  to  another.  For 
some  years  past  voluntary  patients  have  been  admitted  to  the  State 
hospitals  and  later  some  of  these  voluntary  patients  have  been  com- 
mitted thereto.  In  the  statistics  of  the  Commission  some  of  those 
thus  committed  were  counted  twice,  which  accounts  for  a  part  of 
the  above  mentioned  discrepancies. 

NATIVITY  OF  FIRST  ADMISSIONS  TO  THE  STATE  HOSPITALS 

1905-12 
(See  Table  2,  page  88) 

Table  2  gives  the  nativity  of  the  first  admissions  to  the  four- 
teen civil  State  hospitals  for  the  eight  years  beginning  October 
1,  1904,  and  ending  September  30,  1912.  According  to  this  tabu- 
lation, a  total  of  43,515  patients  were  admitted,  of  which  23,- 
2G7,  or  53.5  per  cent,  were  native-born,  and  20,121,  or  46.2  per 
cent,  foreign-born.  The  nativity  of  127,  or  .3  per  cent,  was  un- 
ascertained. Of  the  23,009  males,  12,579,  or  54.7  per  cent,  were 
native-born;  10,349,  or  45  per  cent,  were  foreign-born;  while 
the  nativity  of  81,  or  .3  per  cent,  was  unascertained.  Of  the 
20,506  female  first  admissions,  10,688,  or  52.1  per  cent,  were 
native-born;  9,772,  or  47.7  per  cent,  were  foreign-born;  the 
nativity  of  46,  or  .2  per  cent,  being  unascertained.  This  .2  per 
c^nt  was  probably  foreign-born  and  should  be  treated  as  such. 

From  these  figures  it  will  be  seen  that  while  the  number  of 
male  admissions  exceeded  the  female  admissions  by  2,503,  the 
excess  of  foreign-born  males  over  foreign-born  females  was  only 
577. 

Comparing  the  nativities  of  the  admissions  of  the  several  years, 
it  is  noted  that  there  is  a  gradual  decrease  in  the  native-born  per- 
centages and  a  corresponding  increase  in  the  foreign-born  per- 
centages. 


REPORT  OF   SPECIAL  CoMMissiONEB 


17 


Slight,  however,  as  is  the  increase  in  the  percentage  of  the 
foreign-born  if  it  be  continued  at  its  present  rate  for  about  ten 
years  longer  the  foreign-born  first  admissions  will  equal  in  num- 
bers the  native-born. 

The  percentages  for  the  various  years  appear  as  follows : 

Nativity  of  First  Admissions 


YEAR 

Per  cent 
of  native- 
born 

Per  cent 
of  foreign- 
born 

1905 

55  3 

44  4 

1906 

54  3 

45  2 

1907  .  .  . 

53  8 

46.0 

1908  

51.8 

47.9 

1909  
1910  

53.9 
53.7 

45.9 
46.0 

1911  

52.6 

47.2 

1912 

52  9 

46  9 

The  highest  percentage  of  foreign-born  patients  was  admitted 
in  1908.  In  that  year  the  number  of  foreign-born  females  ad- 
mitted exceeded  by  one  those  of  native  birth. 

Comparing  the  nativity  of  the  first  admissions  for  19:12  with 
the  nativity  of  the  patients  in  the  hospitals  on  September  30, 
1912,  we  find  that  the  percentage  of  foreign-born  among)  the  ad- 
missions exceeded  that  among  the  patients  in  the  hospitals  by  3.5 
per  cent.  This  difference  is  undoubtedly  accounted  for  by  the 
deportations  and  repatriations  of  aliens  previously  referred  to. 

NATIVITY  OF  READMISSIONS 

(See  Table  3,  page  90) 

Table  3  gives  the  nativity  of  the  readmissions  to  the  civil  State 
hospitals  for  the  past  eight  years.  The  table  shows  that  during 
this  period  8,643  patients  were  readmitted,  of  which  5,561  were 
native-born;  3,075  foreign-born;  and  7  of  unascertained  na- 
tivity. The  percentages  of  native  and  foreign-born  were  64.3  and 
35.6  respectively.  It  will  be  noted  that  the  reiadmissions  have  a 
much  higher  percentage  of  native  patients  than  the  first  ad- 
missions. This  difference  is  largely  accounted  for  by  the  fact 


18     ALIEX  IXSA^E  ix  CIVIL  HOSPITALS  OF  KEW  YORK  STATE 


that  the  foreign-born  patients  have  fewer  friends  in  this  country, 
and  consequently  must  reach  a  more  independent  status  before 
being  discharged;  from  the  hospital,  or  in  other  words,  relatively 
fewer  relapsed  cases  would  occur  among  the  foreign-born,  as  fewer 
doubtful  cases  of  this  class  would  be  discharged.  It  should  also  be 
stated  that  many  of  the  readmissions  are  periodically  admitted 
and  therefore  appear  several  times  in  the  count.  The  difference 
is  also  due  to  the  fact  that  many  cases  of  relapsing  psychoses 
were  included  among  those  deported  or  repatriated  after  their 
first  admission. 

Comparing  the  percentages  of  native  and  foreign-born  read- 
missions  during  the  several  years,  we  have : 

Nativity  of  Readmissions 


Per  cent 

Per  cent 

YEAR 

of  native- 

of  foreign- 

born 

born 

1905.. 

64.0 

35.9 

1906  •  

64.3 

35.6 

1907 

66.7 

33.2 

1908  

65.6 

34.4 

1909 

66.7 

33.2 

1910                                                                                       .    . 

64.0 

35.9 

1911                                                

62.6 

37.3 

1912  

62.7 

37.2 

The  above  variations  in  nativity  percentages  in  the  several 
years  are  very  slight  but,  like  the  percentages  of  the  nativity  of 
first  admissions,  show  a  gradual  decrease  in  native-born  and 
a  gradual  increase  in  foreignjborn. 

In  the  readmissions  as  in  the  first  admissions,  the  female  for- 
eign-born patients  exceed  the  male  foreign-born  patients  but  by 
a  larger  percentage,  the  difference  in  rerdmissions  being  8.2  per 
cent  and  in  first  admissions  2.7  per  cent. 

NATIVITY  OF  ALL  ADMISSIONS 
(See  Table  4,  page  92) 

The  nativity  of  all  admissions  to  the  State  hospitals  for  the 
eight  years  from  1905  to  1912  is  given  in  Table  4.  Of  the  52,158 


OF  SPECIAL  COMMISSIONEB 


19 


patients  admitted  28,828,  or  55.3  per  cent,  were  native-born; 
2/3,196,  or  44.5  per  cent,  were  foreign-born;  while  the  nativity  of 
134,  or  .2  per  cent,  was  unascertained. 

The  percentages   of  native  and   foreign-born   for  the  several 
years  were  as  follows: 

Nativity  of  All  Admissions 


YEAR 

Per  cent 
of  native- 
born 

Per  cent 
of  foreign- 
born 

1905.. 
1906  

56.6 
55  8 

43.1 
43  7 

1907 

55  5 

44  3 

1908 

53  7 

46  0 

1909 

56  0 

43  8 

1910  .  .  . 

55  6 

44  2 

1911  

54  5 

45  3 

1912  

54.8 

45  0 

PARENTAGE  OF  FIRST  ADMISSIONS 

(See  Tables  5  and  6,  pages  94,  90) 

Table  5  gives  the  parentage  of  the  first  admissions  to  the  State 
civil  hospitals  for  the  insane  for  the  years  of  1905-12.  Of  the 
23,267  native-born  patients,  11,888  were  of  native  parentage; 
2,346  of  mixed  parentage;  8,306  of  foreign  parentage;  and  727  of 
unknown  parentage.  Of  the  20,121  foreign-born  patients,  26 
were  of  native  parentage;  108  of  mixed  parentage,  19,709  of  for- 
eign parentage;  and  278  of  unknown  parentage. 

Combining  in  Table  6  the  native,  foreign-born  and  unascer- 
tained first  admissions  enumerated  in  Table  5,  we  find  11,914,  or 
-  27.4  per  cent,  of  native  parentage;  2,454,  or  5.7  per  cent,  of 
mixed  parentage;  28,015,  or  64.3  per  cent,  of  foreign  parentage: 
and  1,132,  or  2.6  per  cent,  of  unknown  parentage.  Adding  the 
percentage  of  patients  with  mixed  parentage  to  that  of  patients 
of  foreign  parentage,  we  have  a  total  of  70  per  cent  of  first  ad- 
missions partially  or  wholly  of  foreign  stock.  Tabulating  the 
percentages  of  patients  of  native,  mixed  and  foreign  parentage 
admitted  during  the  several  years,  the  following  results  are  shown : 


20     ALIEN    LNSAM-;  i.\   CIVIL  HOSPITALS  OF  XEW  YoitK  STATE 
Parentage  of  First  Admissions 


YEAR 

Per  cent 
of  native 
parentage 

Per  cent 
of  mixed 
parentage 

Per  cent 
of  foreign 
parentage 

Per  cent 
of  unascer- 
tained 
parentage 

1905 

28.3 

5.0 

62.9 

3.8 

1906 

27  7 

5  7 

62  9 

3  7 

1907  
1908  

28.3 
26.6 

5.5 
5.4 

63.4 
65.3 

2.8 

2.7 

1909 

27.8 

5.5 

64.6 

2.1 

1910  .  . 

26.8 

5.9 

65.3 

2.0 

1911.  .  ....                

27.3 

5.6 

65.2 

1.9 

1912  

26.9 

6.4 

64.7 

2.0 

This  is  similar  to  the  situation  seen  in  the  nativity  summaries 
-  a  gradual  decrease  in  the  native  parentage  percentages  accom- 
panied by  a  gradual  increase  in  the  foreign  parentage  percentages. 

PARENTAGE  OF  READMISSIONS 
(See  Tables  7  and  8,  pages  98,  100) 

Table  7  shows  the  parentage  of  readmissioiis  for  the  years 
1905  to  1912,  inclusive.  Of  the  5,561  native-born  readmissions, 
2,888  were  of  native  parentage;  607  of  mixed  parentage;  1,980  of 
foreign  parentage;  and  86  of  unknown  parentage.  Of  the  3,075 
foreign-born  readmissions,  3  were  of  native  parentage;  23  of 
mixed  parentage;  3,021  of  foreign  parentage;  and  28  of  unknown 
parentage.  The  nativity  of  7  was  unascertained. 

Table  8  combines  all  the  readmissions  of  Table  7  according  to 
parentage.  Referring  to  this  table,  we  find  that  2,891,  or  33.4 
per  cent,  of  the  readmissions  were  of  native  parentage;  630,  or 
7.3  per  cent,,  were  of  mixed  parentage;  5,001,  or  57.9  per  cent, 
were  of  foreign  parentage;  and  121,  or  1.4  per  cent,  were  of  un- 
ascertained parentage. 

The  variations  in  the  percentages  of  the  readmissions  during  the 
eight  years  under  consideration  are  shown  by  the  following  tabu- 
lation : 


REPORT  OF  SPECIAL  COMMISSIONEB 


Parentage  of  Readmissions 


21 


YEAR 

Per  cent 
of  native 
parentage 

Per  cent 
of  mixed 
parentage 

Per  cent 
of  foreign 
parentage 

Per  cent 
of  unascer- 
tained 
parentage 

1905  

34.8 

7.7 

55.6 

1.9 

1906 

32.3 

6.5 

59  0 

2  2 

1907 

34.4 

7.1 

56  0 

2  5 

1908             .                  

35.6 

6.0 

57.5 

0  9 

1909    .                    

37.0 

7.4 

53.8 

1.8 

1910  
1911 

32.9 

29  8 

8.6 

7  9 

57.5 
61  8 

1.0 
0  5 

1912 

32  9 

6  6 

59  3 

1.2 

Here  again  the  native  percentages  slowly  decrease  while  the 
foreign  increase. 


PARENTAGE  OF  ALL  ADMISSIONS 
(See  Tables  9  and  10,  pages  102,  104) 

Tables  9  and  10  give  the  parentage  of  all  admissions  for  the 
years  1905  to  1912. 

As  shown  by  Table  9  of  the  28,828  native-born  patients,  14,- 
776  were  of  native  parentage;  2,953  of  mixed  parentage;  10,286 
of  foreign  parentage;  and  813  of  unknown  parentage.  Of  the 
23,196  foreign-born  patients,  29  were  of  native  parentage;  131 
were  of  mixed  parentage;  22,730  of  foreign  parentage;  and  306  of 
unknown  parentage. 

Combining  in  Table  10,  according  to  parentage,  all  the  admis- 
sions set  forth  in  Table  9,  we  find  that  of  the  total  admissions, 
14,805,  or  28.4  per  cent,  were  of  native  parentage;  3,084,  or  5.9 
per  cent,  were  mixed  parentage;  33,016,  or  63.3  per  cent,  were 
of  foreign  parentage;  and  1,253,  or  2.4  per  cent,  of  unknown  par- 
entage. 

Comparing  the  percentages  of  patients  with  respect  to  parent- 
age during  the  eight  years,  we  have: 


22     ALIEN  INSANE  IN  CIVIL  HOSPITALS  OF  NEW  YORK  STATE 
Parentage  of  All  Admissions 


YEAR 

Per  cent 
of  native 
parentage 

Per  cent 
of  mixed 
parentage 

Per  cent 
of  foreign 
parentage 

Per  cent 
of  unascer- 
tained 
parentage 

1905.  . 

29  3 

5  3 

61  8 

3  6> 

1906 

28  3 

5  8 

62  4 

3  5 

1907  .  .  . 

29  1 

5  7 

62  4 

2  8 

1908  

27  8 

5  5 

64  2 

2  5- 

1909  

29  3 

5  8 

62  8 

2  1 

1910 

27  8 

6  5 

63  9 

1  8- 

1911. 

27  8 

6  0 

64  6 

1  6 

1912.  .  . 

28  0 

6  5 

63  6 

1  £ 

CITIZENSHIP  OF  FIRST  ADMISSIONS 

(See  Table  11,  page  106) 

Table  11  gives  the  citizenship  of  the  first  admissions  to  the- 
State  hospitals  for  the  years  1905-12.  With  respect  to  citizen- 
ship, five  classes  are'  distinguished,  as  follows : 

"  Citizens  by  birth/'  which  includes  all  native-born  patients. 

"  Citizens  by  parentage,"  which  includes  patients  born  in  for- 
eign countries  of  parents  who  were  American  citizens  at  the  time 
of  the  birth  of  the  patient. 

"  'Citizens  by  naturalization,"  which  includes  all  foreign-born 
patients  who  have  been  naturalized  in  any  way  since  coming  to 
this  country. 

"Aliens,"  which  includes  all  foreign-born  patients  who  were 
not  citizens  by  parentage  and  who  have  not  been  naturalized  since 
coming  to  this  country. 

"  Unascertained,"  which  includes  those  patients  concerning 
whose  citizenship  nothing  definite  could  be  determined. 

Of  the  total  first  admissions,  23,267,  or  53.5  per  cent,  were 
citizens  by  birth;  36,  or  .1  per  cent,  were  citizens  by  parentage; 
4,227,  or  9.7  per  cent,  were  citizens  by  naturalization ;  13,913,  or 
31.9  per  cent,  were  aliens;  and  2,072,  or  4.8  per  cent,  were  of  un- 
ascertained citizenship. 

The  percentages  of  the  different  classes  admitted  each  year  are 
shown  by  the  following  tabulation : 


REPOKT  OF  SPECIAL  COMMISSIONER  23 

Citizenship  of  First  Admissions 


YEAR 

Per  cent 
by 
birth 

Per  cent 

by 

parentage 

Per  cent 
by  natur- 
alization 

Per  cent 
aliens 

Per  cent 
unascer- 
tained 

1905  . 

55.3 

0.2 

7.1 

28.4 

9  0 

1906  

54.3 

0. 

8.6 

31.4 

5  6 

1907  

53.8 

0. 

10.9 

32.6 

2.6 

1908 

51  8 

0 

10  4 

33  9 

3  8 

1909                       

53.9 

0 

8  7 

33  4 

3  9 

1910  

53.7 

0. 

8.5 

33  0 

4  7 

1911  
1912  

52.6 
52.9 

0. 
0. 

10.0 

12.8 

32.9 
29.3 

4.4 

4  9 

Here  there  is  a  slow  decrease  in  the  percentages  of  the  native- 
born  citizens  with  a  rapid  increase  in  the  percentages  of  the 
naturalized  citizens.  The  alien  percentages  show  slow  increases 
until  1912,  when  there  is  a  sudden  drop.  This  latter  is  probably 
explained  by  the  fact  that  370  of  the  aliens  deported  and  non- 
residents removed  from  this  State  in  1912  never  became  patients 
in  our  State  hospitals. 


CITIZENSHIP  OF  READMISSIONS 
(See  Table   12,  page  108) 

Table  12  shows  the  citizenship  of  readmissions  to  the  State 
hospitals  for  the  years  1905-12.  Of  the  total  readmissions, 
5,561,  or  64.3  per  cent,  were  citizens  by  birth;  5,  or  .1  per  cent, 
were  citizens  by  parentage;  715,  or  8.3  per  cent,  were  citizens  by 
naturalization;  1,995^  or  23.1  per  cent,  were  aliens;  and  367,  or 
4.2  per  cent,  were  of  unascertained  citizenship.  The  percentage 
of  aliens  among  the  readmissions  is  considerably  less  than  among 
the  first  admissions.  This  corresponds  with  the  nativity  of  the 
two  clases  of  admissions.  A  comparison  of  the  percentages  of  re- 
admissions  of  the  several  years  with  respect  to  citizenship  shows 
the  following: 


24     ALIEN  INSANE  IN  CIVIL  HOSPITALS  OF  NEW  YOKK  STATE 


Citizenship  of  Readmissions 


YEAR 

Per  cent 

by 

birth 

Per  cent 
by 
parentage 

Per  cent 
by  natur- 
alization 

Per  cent 
aliens 

Per  cent 
unascer- 
tained 

1905 

64  0 

7  1 

22  2 

6  7 

1906...           

64  3 

0  2 

8  7 

22  5 

4  3 

1907  
1908 

66.7 
65  6 

8.0 
9  8 

21.3 

20  7 

4.0 
3  9 

1909 

66  7 

0  1 

6  6 

20  9 

5  7 

1910. 

64  0 

6  7 

25  4 

3  9 

1911  

62  6 

0  1 

8  8 

25  5 

3  0 

1912  

62.7 

9.9 

23  8 

3  6 

Here  again  is  a  slight  decrease  in  the  percentages  of  the  native- 
born,  with  increases  in  those  of  the  naturalized  citizens  and  aliens. 
As  4,439  aliens  were  deported  or  repatriated  from  this  State  from 
1905  to  1912  the  increase  in  the  alien  percentage  could  hardly 
have  been  expected. 

CITIZENSHIP  OF  ALL  ADMISSIONS 
(See  Table  13,  page  110) 

Table  13  gives  the  citizenship  of  all  admissions  for  the  years 
1  05-12.  Of  the  total  admissions,  28,828,  or  55.3  per  cent, 
were  citizens  by  birth;  41,  or  .1  per  cent,  were  citizens  by  parent- 
age ;  4,942,  or  9.4  per  cent,  were  citizens  by  naturalization ;  15, 90S, 
or  30.5  per  cent,  were  aliens;  and  2,439,  or  4.7  per  cent,  were 
of  unascertained  citizenship. 

Comparing  the  percentages  shown  of  the  different  classes  for 
each  of  the  eight  years,  we  have  the  following : 

Citizenship  of  All  Admissions 


YEAR 

Per  cent 
by 
birth 

Per  cent 
by 
parentage 

Per  cent 
by  natur- 
alization 

Per  cent 
aliens 

Per  cent 
unascer- 
tained 

1905.  . 

56.6 

0.1 

7.1 

27.5 

8.7 

1906            .    . 

55  8 

0  2 

8  6 

30  0 

5  4 

1907  

55  5 

0 

10  6 

31  0 

2  8 

1908  
1909 

53.7 
56  0 

0. 

o 

10.3 
8  4 

32.1 
31  4 

3.8 
4  1 

1910  .      .    . 

55  6 

8  2 

31  6 

4  6 

1911  
1912 

54.5 
54  8 

0. 

o 

9.7 
12  2 

31.5 
28  3 

4.2 
4  6 

REPORT  OF  SPECIAL  COM  .MIS 


25 


Chart  D 


NATIVITY,  PARENTAGE  AND  CITIZENSHIP' OF  ALL  PATIENTS 

ADMITTED  TO  THE  CIVIL  STATE  HOSPITALS 

1905-1912 


Years 

'Includn  un.K«-rt»,ncd  ca 


26     ALIEN   IN  SANK  IN   CIVIL  HOSPITALS  OF  J^EW  YORK  STATE 

V.  NATIVITY  AND  PARENTAGE  OF  THE  INSANE  AND 
OF  THE  POPULATION  IN  NEW  YORK  STATE 

NATIVITY  OF  INSANK   COMPARED  WITH   NATIVITY  OF   GENERAL 

POPULATION 

A  comparison  of  the  percentages  of  native  and  foreign-born 
among  the  insane  in  the  hospitals  on  September  30,  1912,  and  of 
the  native  and  foreign-born  admissions  during  the  years  1905- 
12,  and  for  the  year  1910,  with  the  native  and  foreign-born  in 
the  general  population  of  the  State  as  given  by  the  Federal  census 
of  1910,  shows  that  the  percentage  of  foreign-born  in  the  insane 
population  is  higher  than  in  the  general  population.  This  differ- 
ence, however,  is  partially  accounted  for  by  the  relatively  large 
number  of  the  foreign-born  in  the  age  groups  in  which  insanity  is 
most  prevalent.  The  facts  are  set  forth  in  the  following  tabula- 
tion : 


Nativity  of  Insane  Compared  with  Nativity  of  General 
Population 


NATIVE-BORN 

FOREIGN-BORN 

Number 

Per  cent 

Number 

Per  cent 

Insane   in   hospitals,    September    30, 

1912,  (Table  1)  

17,896 

56.6 

13,728 

43.4 

First  admissions,  1905-1912  (Table  2)  . 

23,267 

53.5 

20,121 

46.2 

Readmissions,  1905-1912  (Table  3)  .  . 

5,561 

64.3 

3,075 

35.6 

All  admissions,  1905-1912  (Table  4)  .  . 

28,828 

55.3 

23,196 

44.5 

General    population    of    the    State, 

Census  of  1910  

6,365,603 

69.8 

2,748,011 

30.2 

First  admissions,  1910  (Table  2)  

3,151 

53.7 

2,701 

46.0 

Readmissions    1910  (Table  3) 

822 

64.0 

462 

35.9 

All  admissions  1910  (Table  4) 

3,973 

55.6 

3.163 

44.2 

From  the  above  table  it  appears  that  the  foreign-born  in  1910 
constituted  30.2  per  cent  of  the  entire  population  of  the  State, 
while  the  foreign-born  insane  constituted  43.4  per  cent  of  the 
patients  in  the  State  hospitals  September  30,  1912;  46.2  per  cent 


REPORT  OF  SPECIAL  COMMISSIONER  27 

of  the  first  admissions  ;  35.G  per  cent  of  the  read  missions  ;  and  44.5 
per  cent  of  all  admissions  from  1905  to  1912. 

If  the  percentages  of  the  first  'admissions,  of  the  readmissions 
mid  of  all  admissions  for  1910  are  used  as  the  basis  for  compari- 
son with  the  census  figures  instead  of  the  corresponding  per- 
centages covering  the  eight  years  from  1908  to  1912,  the  result 
shows  hut  little  variation  from  that  ahove  stated,  as  the  respective 
percentages  are  practically  identical. 

The  census  taken  by  the  federal  government  as  of  December 
31,  1903,  gives  the  number  of  foreign-bom  patients  in  the  Xew 
York  civil  hospitals  for1  the  insane  as  11,258  or  46.2  per  cent  of 
the  total.  This  is  2.8  per  cent  higher  than  the  percentage  of 
September  30,  1912,  as  above  stated. 

Two  enumerations  taken  by  ISew  York  State  in  February,  1909, 
and  February,  1912,  found  the  foreign-born  in  its  civil  insane 
.hospitals  to  number  12,253,  or  42.9  per  cent  and  13,163,  or  41.9 
per  cent  on  the  respective  dates.  The  percentage  of  the  first 
.enumeration  varies  but  .5  per  cent  and  of  the  second  1.5  per  cent 
from  the  43.4  above  given  for  September  30,  1912. 


OF  THE  PARENTAGE  OF  THE  INSANE  WITH  THAT  OF 
THE  GENERAL  WHITE  POPULATION 

The  first  of  the  two  following  tabulations  deals  with  the  par- 
entage of  all  admissions  to  the  Xew  York  State  hospitals  whose 
parentage  was  ascertained  and  the  second  only  with  the  native- 
born  admissions  whose  parentage  was  ascertained. 

Comparison  with  the  white  population  is  necessitated  by  rea- 
son of  the  inaccessibility,  at  this  time,  of  census  tabulations  on 
the  parentage  statistics  of  the  entire  population.  This,  however 
makes  but  little  difference  as,  according  to  the  U.  S.  census  of 
1910  those  other  than  whites  numbered  but  146,769  in  Xew 
York  State  out  of  a  total  'State  population  of  9,113,614. 

1.  Comparison  of  the  parentage  of  admissions  (excluding  those 
of  unknown  parentage)  to  the  ~New  York  State  hospitals,  1905- 
1912  with  that  of  the  general  white  population  of  the  State. 


28 


l:\sA.\E  IN  CIVIL  HOSPITALS  OF  NEW  YOEK  STATE 


REPORT  OF  SPECIAL  COMMISSIONER 


29 


Per  cent 
native 

Per  cent 
foreign  or 

parentage 

parentage 

First  admissions    1905-1912  (Table  6) 

27  4 

70  0 

Readmissions,  1905-1912  (Table  8) 

33  4 

65  2 

All  admissions,  1905-1912  (Table  10) 

28  4 

69  2 

General  white  population  of  the  State,  U.  S.  Census  of  1910  .  .  . 

35.4 

62.9 

2.  Comparison  of  the  parentage  of  the  native-born  admissions 
(excluding  those  of  unknown  parentage)  with  that  of  the  native- 
born  white  population  of  the  state. 


Per  cent 
native- 
born  of 
native 
parentage 

Per  cent 
native- 
born  of 
foreign 
or  mixed 
parentage 

First  admissions,  1905-1912  (Table  5)..    . 

52.7 

47  3 

Readmissions,  1905-1912  (Table  7)  

52.7 

47.3 

All  admissions,  1905-1912  (Table  9)  

52.7 

47.3 

Native  white  population  of  the  State,  U.  S.  Census  of  1910.  .. 

51.8 

48.2 

The  first  tabulation  shows  a  considerably  less  percentage  of 
those  of  native  parentage  and  a  considerably  greater  percentage 
of  those  of  foreign  or  mixed  parentage  among  the  first  admissions 
and  all  admissions  to  the  New  York  State  hospitals  than  there 
was  among  the  white  population  of  the  State  in  1910. 

This  indicates  that  there  is  a  relatively  greater  proportion  of 
foreign  parentage  among  those  admitted  to  the  hospitals  than  in 
the  State  at  large;  in  other  words  that  foreign  parentage  contri- 
utes  more  than  its  share  to  our  hospital  population. 

The  reasons  for  the  higher  percentage,  in  the  first  tabulation,  of 
those  of  native  parentage  among  the  readmissions  are  the  same  as 
those  heretofore  stated  concerning  the  nativity  of  the  readmis- 
sions. 

From  the  second  tabulation,  which  deals  only  with  the  native- 
born,  it  is  apparent  that  the  native-born  element  in  the  New  York 
'State  hospital  population  is  practically  indentical  in  parentage 


30     ALIE.X   INSANE  ix  CJVIL  HOSPITALS  OF  XEW  YORK  STATE 

with  that  of  the  native  white  population  of  the  State  in  1910.,  the 
difference  being  .9  per  cent. 

United   States  census   statistics   are  not  available  from  which 
comparisons  of  the  foreign-born  and  aliens  can  be  made. 


VI.     NATIVITY,  PARENTAGE  AND  INSANITY  IN  NEW 
YORK  STATE  AND  THE  UNITED  STATES 

COMPARISON  OF  THE  POPULATION  OF  XEW  YORK  STATE  WITH 
THAT  OF  THE  UNITED  STATES  WITH  RESPECT  TO  NATIVITY,. 
PARENTAGE  AND  INSANITY 

As  Xew  York  State  contains  the  principal  Atlantic  seaport,  a 
large  proportion  of  the  foreigners  coming  to  this  country  enter  the 
State,  and  of  these  relatively  a  large  number  remain  in  the  State. 
During  1912,  28.5  per  cent  of  all  the  immigrants  who  came  to 
this  country  announced  their  intention  of  residing  in  this  State. 
The  following  tabulation  shows  the  foreign  element  in  New  York 
State  to  be  relatively  much  larger  than  in  the  United  States  as 
a  whole: 

Comparisons  of  the  Population  of  the  United  States  and  of  New 
York  State.     (From  Federal  Census  of  1910) 


UNITED 

STATES 

NEW  TORI 

£  STATE 

Number 

Number 

Per  cent 
of 
United 

States 

Total  population  

91,972,266 

9,113,614 

9.90 

Total  white  population  
Total  foreign-born  white  population  
Total  native-born  white  population  of  foreign 
parentage  
Total  native-born  white  population  of  mixed 
parentage 

81,731,957 
13,345,545 

12,916,311 
5  981  526 

8,966,845 
2,729,272 

2,241,837 
765,411 

10.97 
20.40 

17.35 
12  80 

Total  white  population  of  foreign  birth  or  of 
foreign  or  mixed  parentage  
Total  native-born  white  population  
Total  native-born  white  population  of  native 
parentage 

32,243,382 
68,386,412 

49  488  575 

5,736,520 
6,237,573 

3,230,325 

17.80 
9.12 

6  52 

Insane  in  institutions  (January  1,  1910).  .  .  . 

187,454 

31,265 

16.70 

REPORT  OF  SPECIAL  COMMISSIONER 


31 


Chart  F 
COMPARISON  OF  THE  POPULATION  OF  THE  UNITED  STATES  AND  OF  NEW  YORK  STATE 

(FROM  FEDERAL  CENSUS  OF  1910) 

PER  CENT  IN  NEW  YORK  STATE 
0                  5                 10                 15                20                25               30 

White  population 

^ 

Foreign  bom  white  population 

• 

1  

i 

Native  bom  white  population  of  foreign.  parentage 

»••••                i                                         i 

:::jmmmmm 

c. 

—  ^—  —  — 

Native  bom  white  population  of  mixed  parentage 

ar~i  i 

12.8   J 
^  

White  population  of  foreign  birth  or  of  foreign  or 
mixed  parentage 

- 

•_ 

___-_____ 

Native  born  white  population 

I^LHBBL 

Native  born  white  population  of  native  parentage 

•^•^•••••IM        '1                                            .•!•••                           1      ••         .                                         I.....                                         .                                                     .    ...     • 

6.52.  [              H__ 

Insane  in  institutions  (January  I,  1910) 

^•••••••••••••••••••^••^^^^^^•••^^•••^        i  •••  .••«  •  •••• 

_^^^^_^^^__ 
16.7    | 

1        1 

• 

•- 

32     ALIEN    INSANE   IN   CIVIL   HOSPITALS  OF   NEW  YORK  STATE 


Foreign-born  white  population 

Native-born  white  population  of  foreign  or  mixed  parentage. . 
Total  white  population  of  foreign  birth  or  of  foreign  or  mixed 

parentage 

Total  native-born  white  population  of  native  parentage...  . 


PER  CENT  OF  TOTAL 
POPULATION 


United 
States 


14.5 
20.5 

35.0 

53.8 


New  York 

State 


29.9 
33.0 

62.9 
35.4 


Foreign-born  white  population 

Native-born  white  population  of  foreign  or  mixed  parentage. . 
Total  white  population  of  foreign  birth  or  of  foreign  or  mixed 

parentage 

Total  native-born  white  population  of  native  parentage .... 


PER  CENT  OF  TOTAL 
WHITE  POPULATION 


United 

States 

New  York 

State 

16.3 
23.1 

30.4 
33.5 

39.4 
60.5 

63.9 
36.0 

From  the  above  tables  it  appears  that  while  ISTew  York  has  but 
9.9  per  cent  of  the  total  population  of  the  United  States  it  has 
20.4  per  cent  of  the  total  foreign-born  white  population,  and  17.8 
per  cent  of  the  total  white  population  of  foreign  birth  or  of  for- 
eign or  mixed  parentage.  While  it  contains  10.97  per  cent  of  the 
total  white  population  it  has  but  6.52  per  cent  of  the  total  native- 
born  white  population  of  native  parentage.  The  insane  in  in- 
stitutions in  New  York  State  comprise  1C. 7  per  cent  of  the  total 
insane  in  institutions  in  the  United  States. 

Comparing  the  percentages  of  the  foreign-born  whites  we  find 
that  while  in  the  United  States  but  14.5  per  cent  of  the  total 


KEPOKT  or  SPECIAL  COMMISSIONER  33 

population  and  16.3  per  cent  of  the  total  white  population  are 
foreign-bo-m,  in  New  York  State  the  corresponding  percentages 
of  the  foreign-born  are  2\).\)  per  cent  and  30.4  per  cent. 

The  percentages  of  native-born  white  population  of  foreign 
or  mixed  parentage  in  the  total  population  and  total  white  popula- 
tion of  the  United  States  are  respectively  20.5  and  23.1,  and  in 
New  York  State  are  respectively  33  and  33.5. 

The  corresponding  percentages  of  the  total  white  population 
of  foreign  birth  or  of  foreign  or  mixed  parentage  in  the  United 
States  are  35  and  39.4  and  in  New  York  State  62.9  and  63.9. 

In  the  United  States  at  large  the  native-born  white  population 
of  native  parentage  comprises  53.8  per  cent  of  the  total  popula- 
tion and  60.5  per  cent  of  the  total  white  population,  while  in  New 
York  State  the  native-born  whites  of  native  parentage  compose  but 
35.44  per  cent  of  the  total  population  of  the  State  and  36  per 
cent  O'f  its  total  white  population. 

The  data  of  the  Federal  census  of  1910  concerning  the  nativity 
of  the  foreign-born  insane  in  institutions  in  the  United  States 
are  not  available,  but  taking  the  figures  from  the  Federal  census 
report  of  1904  we  note  that  in  that  year  there  were  in  all  insti- 
tutions (civil,  criminal  and  private)  in  New  York  State  11,858 
foreign-born  insane  patients,  while  in  the  whole  country  there 
were  only  47,078.  It  appears,  therefore,  that  in  1904  New 
York  State  was  caring  for  25.2  per  cent  of  the  foreign-born  insane 
of  the  whole  country.  Inasmuch  as  the  foreign-born  element 
in  New  York  State  has  increased  since  1904  relatively  much 
more  rapidly  than  the  native-born  element,  it  is  probable  that 
the  proportion  of  the  fo-reign-born  insane  patients  of  the  whole 
country  cared  for  by  the  State  of  New  York  has  likewise  in- 
creased. 

As  it  appears  from  Table  11,  giving  the  citizenship  of  first 
admissions  to  the  State  hospitals  for  the  insane,  that  13,913,  or 
31.9  per  cent  of  all  the  first  admissions  to  the  hospitals  from 
1905  to  1912  were  aliens,  it  is  evident  that  the  State  of  New 
York  receives  more  than  its  just  share  of  the  alien  insane  in  this 
country. 

It  is  to  be  regretted  that  statistics  of  the  citizenship  of  the  in- 
2 


34     ALIEX  INSANE  IN  CIVIL  HOSPITALS  OF  ATEW   YORK  STATE 

sane  in  institutions  throughout  the  whole  country  are  not  avail- 
able. However  this  may  be  remedied  before  many  years  as 
already  statistics  similar  to  those  given  herein  are  being  prepared 
by  several  other  States  at  the  suggestion  of  this  Commission. 


VII.     TIME  OF  ALIENS  IN  UNITED  STATES  BEFORE 
ADMISSION  TO  THE  STATE  HOSPITALS 

(See  Table  14,  page  112) 

Table  14  shows  the  time  in  the  United  States  before  admission 
to  the  .Xew  York  civil  hospitals  of  the  first  admissions  from 
1905  to  1912  who  were  aliens  or  of  unascertained  citizenship. 

Classified  with  respect  to  time,  four  groups  are  distinguished, 
as  follows :  Those  admitted  to  the  hospitals  within  three  years 
after  entry  into  the  United  States,  those  admitted  more  than 
three  years  but  within  five  years  after  entry  into  the  United 
States,  those  admitted  more  than  five  years  after  entry  into  the 
United  States,  and  those  whose  time  of  entry  into  the  United 
States  could  not  be  ascertained. 

Of  the  15,985  patients  who  were  either  aliens  or  of  unascer- 
tained citizenship,  2,831,  or  17.7  per  cent,  were  admitted  to  the 
New  York  State  hospitals  within  three  years  after  entry  into 
the  United  States;  1,483,  or  9.3  per  cent,  were  admitted  more 
than  three  years  but,  within  five  years  after  entry  into  the  United 
States;  10,271,  or  64.3  per  cent,  were  admitted  more  than  five 
years  after  entry  into  the  United  States.  The  time  of  entry 
into  the  United  States  of  1,4.00,  or  8.7  per  cent,  of  the  first  ad- 
missions, could  not  be  ascertained. 

A  tabulation  of  the  percentages  of  each  of  the  four  groups, 
classified  with  respect  to  time  in  the  United  States  before  admis- 
sion, shows  the  following  results: 


REPORT  OF  SPECIAL  COMMISSIONER 


35 


Per  Cent  Distribution  According  to  Time  in  United  States  Be- 
fore Admission  to  New  York  State  Hospitals  of  Aliens  and  of 
Patients  Whose  Citizenship  is  Unascertained,  1905-1912. 

FIRST  ADMISSIONS 


More  than  3 

Within  3 

years  but 

More  than  5 

years  after 

within  5 

years  after 

Time 

YEARS 

entry  into 

years  after 

entry  into 

un- 

the United 

entry  into 

the  United 

ascertained 

States 

the  United 

States 

States 

1905 

14.7 

6.8 

67.3 

11.2 

1906 

18.7 

8.2 

63.8 

9.3 

1907  ...           

21.8 

8.6 

58.  7 

10.9 

1908  

20.1 

9.2 

60.3 

10.4 

1909  

18.1 

9.6 

64.2 

8.1 

1910 

15.5 

10.8 

65.8 

7.9 

1911. 

14.9 

11.5 

66.4 

7.2 

1912. 

18.1 

8.7 

67.5 

5.7 

As  five  years  must  elapse  after  the  coming  of  a  foreigner  to  this 
country  before  he  can  become  a  naturalized  citizen,  it  is  evident 
that  at  least  2,352  of  the  male  first  admissions  entered  the  State 
hospitals  during  the  period  under  consideration  before  having  had 
an  opportunity  to  become  citizens.  Of  the  others  included  in 
Table  14  at  least  5,317  males  were  in  this  country  long  enough 
•to  obtain  citizenship  papers  but  so  far  as  could  be  ascertained, 
did  not  take  advantage  of  their  opportunity. 

Table  15  gives  the  time  in  the  United  States  before  readmissioii 
to  the  New  York  State  hospitals  of  aliens  and  of  patients  whose 
citizenship  is  unascertained  readmitted  to  the  hospitals  between 
1905-12.  It  is  probable  that  several  of  these  readmissions  had 
been  in  a  hospital  in  a  foreign  country  before  coming  to  the 
United  States,  but  the  number  of  such  cases  could  not  be  ascer- 
tained. Of  the  readmissions  115,  or  5  per  cent,  of  the  patients 
were  readmitted  to  the  State  hospitals  within  three  years  after 
entry  into  the  United  States;  and  113,  or  4.8  per  cent,  more  than 
three  but  within  five  years  after  entry ;  while  1,973,  or  83.4  per 
cent,  were  readmitted  more  than  five  years  after  their  entry  into 
the  United  States. 


36     ALIEN  INSANE  IN  CIVIL  HOSPITALS  OF  NEW  YORK  STATE 

The  number  of  patients  readmitted  to  the  hospitals  more  than 
five  years  after  their  entry  into  this  country  has  increased  68  per 
cent  from  190,5  to  1912. 

Table  16  is  a  summary  of  Tables  14  and  15  and  shows  the  time 
of  admission  to  the  'State  hospitals  after  entry  into  the  United 
States  of  the  whole  number  of  aliens  and  of  patients  of  unascer- 
tained citizenship  admitted  or  readmitted  during  the  years  1905- 
12.  Of  these,  2,946,  or  16.1  per  cent,  were  admitted  or  re- 
admitted to  the  hospitals  before  having  been  in  this  country  three 
years;  1,596,  or  8.7  per  cent,  were  admitted  or  readmitted  more 
than  three  years  but  within  five  years  after  entry  into  the  United 
States;  12,244,  or  66.7  per  cent,  were  admitted  or  readmitted 
more  than  five  years  after  entry  into  the  United  States.  The  time 
in  the  United  States  before  admission  or  readmission  of  1,561,  or 
8.5  per  cent,  was  unascertained. 


VIII.    COST  OF  CARING  FOR  THE  ALIEN  INSANE 
From  the  financial  standpoint  there  are  three  classes  of  patients 
in  the  civil  hospitals  of  New  York  State  viz : 

1.  Patients  supported  entirely  by  the  State  —  these  are  termed 
nonpaying  patients. 

2.  Patients  who  repay  to  the  State  part  or  all  of  the  bare  cost  of 
their  maintenance  up  to  $5  per  week. 

3.  Patients  who  pay  to  the  State  more  than  $5   but  not  to 
exceed  $10  per  week. 

The  last  two  classes  of  patients  are  herein  called  paying 
patients. 

On  September  30,  1912,  the  aliens  in  the  population  of  the 
ISTew  York  civil  hospitals  for  the  insane  numbered  9,241,  or  29.2 
per  cent  of  the  total  hospital  population.  This  is  probably  some- 
what less  than  the  average  daily  alien  population  for  1912,  as  dur- 
ing that  year  961  aliens  were  deported  or  repatriated  from  the 
ISTew  York  civil  hospitals  by  the  Bureau  of  Deportation  none  of 
whom  were  in  the  State  hospitals  on  September  30,  1912.  More- 
over it  is  well  knowrn  that  of  the  402  nonresident  insane  returned 
to  other  states  in  1912  from  the  civil  hospitals  by  the  Bureau  of 
Deportation  many  were  aliens.  In  addition  to  this,  Table  11 


KEPOKT  OF  SPECIAL  COMMISSIONER 


37 


shows  that  the  alien  patients  constituted  31.9  per  cent  of  all  the 
first  admissions  to  the  civil  hospitals  from  1905  to  1912  inclusive 
and  29.3  per  cent  of  the  first  admissions  for  1912,  which  per- 
centages are  exclusive  of  all  patients  whose  citizenship  was  unas- 
certained. It  seems  reasonable,  therefore,  to  assume  that  the 
average  daily  alien  patient  population  in  the  civil  hospitals  for 
1912  numbered  at  least  9,241. 

In  April,  1913,  a  special  census  of  the  paying  patients  in  the 
civil  hospitals,  taken  by  the  State  Hospital  Commission,  showed 
that  109  were  known  to  be  aliens  and  103  were  of  unascertained 
citizenship.  As  the  total  number  of  paying  patients  increased 
189  or  7.2  per  cent  from  September  30,  1912  to  September  30, 
1913,  it  is  not  prejudicial  to  the  alien  to  assume  that  on  Septem- 
ber 30,  1912,  there  were  only  212  paying  patients  in  our  hospitals 
who  were  aliens  or  of  unascertained  citizenship. 

The  following  is  a  summary  and  comparison  of  the  paying  and 
nonpaying  patients  in  the  civil  hospitals  on  September  30,  1912, 
classified  according  to  citizenship: 

Paying  and  Nonpaying  Patients  Classified  According  to 

Citizenship 


TOTAL 

PAYING 

PATIENTS 

NONPATING 

PATIENTS 

Number    Per  cent 

Number 

Per  cent 

Number 

Per  cent 

Patient  population, 
Citizens  (native  bo 
Aliens  

Citizens 

Per  cents 

September  30,  1912 
rn  and  naturalized) 

based  on  total  of  eac 

31,624        100.0 
22,383        100.0 
9,241   ,     100.0 

ased  on  total  patient 

22,383  1       70.8 
9,241   |       29.2 

sed  on  subtotal  in  ea 

h  group 

2,613 
2,401 
212 

populatio 

2,401 
212 

ch  diiisioi 

8.26 
10.73 
2.30 

n 

7.59 
0.67 

1 

29,011 
19,982 
9,029 

19,982 
9,029 

91.74 
89.27 
97.70 

63.21 
28.53 

Per  cents  b 

Aliens  

Per  cents  ba 

Citizens  

22  383 

70  8 

2  401 

91  89 

19  982 

68  88 

Aliens  

9,241 

29.2 

212 

8  11 

9,029 

31.12 

Subtotal 

31  624 

100  0 

2  613 

100  00 

29  Oil 

100  00 

From  the  first  portion  of  the  foregoing  tabulation  it  appears  that 
on  September  30,  1912,  of  the  total  patient  population  in  the  civil 
hospitals  of  New  York  State  (numbering  31,624)  2,613,  or  8.26 


38     ALIEN  INSANE  IN  CIVIL  HOSPITALS  OF  NEW  YOKK  STATE 

per  cent,  were  paying  patients  and  29,011,  or  91.74  per  cent 
were  nonpaying  patients;  that  of  the  total  citizen  patient  popula- 
tion (numbering  22,383)  2,401,  or  10.73  per  cent,  were  paying 
patients  and  19,982,  or  89.27  per  cent,  were  nonpaying  patients, 
while  of  the  total  alien  patient  population  (numbering  9,241)  212, 
or  2.3  per  cent,  were  paying  patients  and  9,029,  or  97.7  per  cent, 
were  nonpaying  patients. 

From  the  second  portion  of  the  above  tabulation  it  is  apparent 
that  the  citizen  paying  patients  composed  7.59  per  cent  of  the  total 
patient  population  while  the  citizen  nonpaying  patients  were  63.21 
per  cent  thereof;  that  the  alien  paying  patients  comprised  .67  per 
</ent  of  the  total  patient  population  while  the  alien  nonpaying 
patients  constituted  28.53  per  cent  of  such  total. 

By  the  third  portion  of  the  tabulation  it  is  shown  that  the 
citizen  patient  population  furnished  91.89  per  cent  of  all  the 
paying  patients  and  68.88  per  cent  of  all  the  nonpaying  patients, 
while  the  alien  patient  population  contributed  8.11  per  cent  of 
all  the  paying  patients  and  31.12  per  cent  of  all  the  nonpaying 
patients. 

The  citizen  population,  though  but  2.4  times  the  alien  popula- 
tion, furnished  11.3  times  as  many  paying  patients  as  the  latter. 
In  other  words  the  proportion  of  paying  patients  among  the 
citizen  population  was  4.7  times  as  great  as  among  the  alien 
population. 

In  1912  the  total  received  by  the  State  of  New  York  from  pay- 
ing patients  was  $500,475.82  of  which  8.11  per  cent  or  $40,588.59 
came  from  the  alien  insane  patients  and  91.89  per  cent,  or  $459,- 
887.23,  was  paid  by  the  citizen  insane  patients.  The  foregoing 
figures  are  as  favorable  as  possible  to  the  alien  paying  patients  as 
they  are  based  upon  the  assumption  that  the  average  alien  paying 
patient  paid  the  State  the  same  amount  as  the  average  citizen  pay- 
ing patient. 

An  approximation  of  the  alien  per  capita  payment  to  the  State 
of  New  York  in  1912  is  reached  if  the  total  payment  to  the  State 
of  New  York  by  the  alien  insane  in  1912,  $40,588.59,  is  divided 
by  9,241.  The  result  is  $4.39.  which  represents  the  average  per 
capita  payment  to  the  State  of  New  York  by  the  alien  insane  in 


KEPOKT  OF   IS  FILIAL  COM  AIKSSIOAKK  39 

1912.  If  the  total  payment  to  the  State  by  the  citizen  insane 
patients  in  1912,  $459,887.23,  is  divided  by  22,383,  the  number 
of  citizen  insane  in  the  State  hospitals  September  30,  1912,  the 
result  is  $20.55,  which  is  the  average  per  capita  payment  by  each 
citizen  insane  patient  in  1912. 

The  average  daily  population  in  the  civil  hospitals  of  New 
York  State  for  1912  was  31,580  and  the  population  September 
30,  1912,  was  31,624,  or  44  more  than  the  daily  average.  If  the 
$500,475.82  paid  to  the  State  in  1912  by  paying  patients  is 
divided  either  by  31,580  or  by  31,624  the  result  is  substantially 
the  same  —  a  trifle  less  than  $16  —  which  represents  the  average 
per  capita  payment  to  the  State  by  each  patient  (whether  citizen 
or  alien)  during  the  year  1912. 

It  is  apparent,  therefore,  that  the  patient  average  per  capita 
payment  to  the  State  for  1912  ($16)  was  $4.55  less  than  the 
citizen  per  capita  average  ($20.55)  but  was  $11.61  more  than  the 
alien  per  capita  average  ($4.39). 

Table  17  showis  that  the  per  capita  gross  cost  of  maintenance  of 
all  patients  in  the  New  York  State  civil  hospitals  for  1912  was 
$203.45.  Taking  from  this  the  patient  per  capita  average  pay- 
ment to  the  State  during  1912  ($16)  leaves  $187.45  which  is  the 
patient  per  capita  net  cost  of  maintenance  for  1912.  If  this  is 
multiplied  by  9,241  —  the  number  of  aliens  in  the  civil  hospitals 
September  30,  1912  —  the  result  is  $1,732,225.45. 

If  the  alien  per  capita  average  payment  to  the  State  for  1912 
($4.39),  instead  of  the  patient  per  capita  average  payment  ($16), 
is  deducted  from  the  per  capita  gross  cost  of  maintenance  for  1912 
($203.45)  the  result  is  $199.06  and  not  $187.45.  This  $199.06 
is  the  alien  per  capita  net  cost  of  maintenance  for  1912.  On  this 
*  basis  the  net  maintenance  cost  for  1912  of  the  9,241  aliens  would 
be  $1,839,513.46,  or  $107,288.01  more  than  the  previous  figures. 

This  should  be  a  close  approximation  of  the  net  cost  of  the  alien 
insane  to  the  State  of  New  York  for  hospital  care  alone  (includ- 
ing food,  clothes  and  treatment)  for  the  year  1912. 

For  the  same  year  New  York.  State's  gross  expenditure  for  the 
insane  was  $7,360,536.43  of  which  the  alien  patients'  share  was 
29.2  per  cent  or  $2,149,276.64  and  the  citizen  patients'  share  was 


4:0     ALIEN   INSANE  IN  CIVIL  HOSPITALS  OF  NEW  YORK  STATE 

70.8  per  cent  or  $5,211,259.79.  Deduct  from  the  alien  patients' 
share  $40,588.59,  the  total  amount  received  by  the  State  in  1912 
from  alien  paving  patients,  and  the  result  is  $2,108,688.05,  which 
is  the  amount  of  the  net  expenditure  of  the  State  of  New  York  for 
the  alien  insane  in  1912.  If  the  last  mentioned  amount  is  divided 
by  9, 241,  the  number  of  alien  patients  on  September  30,  1912, 
the  quotient  is  $228.19,  which  is  the  per  capita  net  expenditure 
of  the  State  for  each  alien  insane  patient  in  1912.  If  from  the 
citizen  patients'  share  of  the  gross  expenditures,  which  is  $5,211,- 
259.79,  is  deducted  $459,887.23,  the  total  received  by  New  York 
State  in  1912  from  citizen  paying  patients,  the  remainder  is 
$4,751,352.56,  which  is  the  State's  net  expenditure  for  its  citizen 
insane  in  1912.  Dividing  the  last  amount  by  22,383,  the  number 
of  citizen  patients  September  30,  1912,  gives  $212.27,  the  per 
capita  net  expenditure  of  New  York  for  each  citizen  patient  in 
1912.  If  the  total  net  expenditure  for  1912,  $6,860,060.61,  is 
divided  by  31,624,  the  total  number  of  patients  September  30, 
1912,  the  quotient  is  $216.93,  the  per  capita  net  expenditure  for 
the  year  for  the  average  patient  (whether  citizen  or  alien). 

The  above  figures  show  that  New  York  State's  net  expenditure 
in  1912  was  $15.92  more  for  each  alien  insane  patient  than  for 
each  citizen  insane  patient  and  was  $11.26  more  for  each  alien 
than  for  the  average  (citizen  or  alien)  patient  but  that  for  each 
citizen  patient  the  net  expenditure  was  $4.66  less  than  for  the 
average  patient. 

The  foregoing  figures  of  costs  for  hospital  care  and  for  net 
expenditure  for  the  alien  insane  for  1912  are  very  conservative 
so  far  as  the  alien  patient  is  concerned,  as  they  take  no  account  of 
aliens  deported,  repatriated  or  returned  from  the  New  York  civil 
hospitals  by  the  Bureau  of  Deportation  during  1912. 

The  estimate  of  $2,108,688.05  for  the  alien  insane  for  1912 
is  for  net  expenditure  only.  It  takes  no  account  of  any  charge 
for  interest  on  the  investment  of  New  York  State  in  hospitals,, 
lands  and  personal  property  estimated  in  1912  as  of  the  total 
value  of  $33,781,450. 

In  1912  the  State  Hospital  Commission  estimated  the  gross  cost: 
for  that  year  to  the  State  of  each  insane  patient  to  be  $283.57,  as. 
follows : 


KEPORT  OF  SPECIAL  COMMISSIONER  41 

Annual  cost  of  maintenance $203  45 

Annual   cost   on   account   of   investment   in   hospital 

plants 74  78 

Annual  cost  of  general  administration 5  34 


$283  57 

The  net  cost  per  patient  for  1912,  therefore,  would  be  $283.57 
less  the  patient  per  capita  average  payment  to  the  State  in  1912 
($16),  or  $267.57. 

At  this  rate  the  9,241  insane  aliens  in  the  civil  hospitals  on 
September  30,  1912,  would  have  entailed  upon  the  State  of  New 
York  for  that  year  a  net  cost  of  $2,472,614.37. 

If  instead  of  deducting  the  patient  per  capita  average  pay- 
ment ($16),  the  alien  per  capita  average  payment  to  the  State  for 
1912  ($4.39)  is  subtracted  from  the  $283.57  above,  the  net  cost 
for  1912  for  each  alien  patient  is  found  to  be  $279.18.  On  this 
basis  the  net  cost  to  New  York  State  for  1912  of  its  9,241  alien 
insane  would  be  increased  by  $107,288.01,  making  the  total 
$2,579,902.38. 

This  estimate  does  not  take  into  account  the  hundreds  of  aliens 
removed  from  the  State  hospitals  in  1912. 

A  census  of  the  foreign-born  patients  in  the  State  hospitals 
taken  in  February,  1912,  showed  that  the  average  length  of  hos- 
pital residence  was  9.85  years.  This  is  probably  a  fair1  and  low 
average  as  most  well  informed  authorities  estimate  the  average 
hospital  life  of  the  insane  patients  (whether  alien  or  citizen)  in 
the  civil  hospitals  of  New  York  State  at  ten  years  and  over.  It 
follows,  therefore,  that  the  average  net  cost  of  maintaining  an 
alien  patient  for  the  time  of  his  average  residence  in  the  New 
York  State  hospitals,  at  $279.18  per  annum  is,  $2,749.92  exclu- 
sive of  interest  and  that  the  total  probable  net  cost  to  the  State  of 
the  9,241  aliens  in  the  State  hospitals  September  30,  1912,  if 
allowed  to  complete  their  average  hospital  residence,  will  be 
$25,412,038.44. 

It  must  be  borne  in  mind  that  there  are  two  hospitals  for  the 
criminal  insane  having  a  population  on  September  30,  1912,  of 


42     ALIEN  INSANE  IN  CIVIL  HOSPITALS  or  NEW  YORK  STATE 


1,272,  none  of  the  aliens  among  whom  are  included  in  the  figures 
of  this  report,  and  that  in  1912,  198  aliens  were  deported  and 
172  nonresidents  were  returned  from  the  psychopathic  wards  of 
Bellevue  and  Kings  County  hospitals  and  various  other  institu- 
tions other  than  State  hospitals. 

Summary  of  Costs  and  Expenditures  for  1912 


Average 
patient 

Average 
citizen 
patient 

Average 
alien 
patient 

Per  capita  payment  to  state 

$16  00 

$20  55 

$4  39 

Net  cost  of  maintenance  (food,  clothes  and  treat- 
ment)    .  .  .  .  

187  45 

182  90 

199  06 

Net  expenditure  (maintenance,  construction  and 
repairs) 

216  93 

212  27 

228  19 

Total  net  cost  (maintenance,  depreciation,  in- 
terest and  general  expense)  .  . 

267  57 

263  02 

279  18 

Taking  the  costs  of  and  the  expenditure  for  the  average  alien 

patient,  as  above  set  forth,  the  totals  would  be: 

Per  capita  total  net  cost  of  entire  hospital  resi- 
dence of  average  alien  patient $2,749  92 

Total  net  cost  of  maintenance  of  all  the  alien 

insane  for  1912 1,839,513  46 

Total  net  expenditure  for  all  the  alien  insane 

for  1912  2,108,688  05 

Total  net  cost  of  all  the  alien  insane  for  1912.  .        2,579,902   33 

Total  net  cost  of  all  the  alien  insane  in  civil 
hospitals  in  1912  for  average  hospital  resi- 
dence    25,412,038  44 


For  the  year  ending  September  30,  1912,  the  expenditures  of 
the  Bureau  of  Deportation  were  $46,939.24.  During  the  same 
period  961  aliens  were  deported  or  repatriated  and  402  non- 
residents removed  from  the  civil  hospitals  of  New  York,  a  total 
of  1,363  aliens  and  nonresidents  taken  from  the  civil  hospitals, 
and  in  addition  to  these  12  aliens  and  8  nonresidents  were  sent 
home  in  this  year  from  Matteawan  and  Dannemora,  while  198 


KEPORT  OF  SPECIAL  COMMISSIONER  43 

aliens  and  172  nonresidents  were  removed  from,  hospitals  and 
other  institutions,  in  all  390  additional.  The  whole  number  sent 
from  the  State  in  1912  was  1,753. 

As  the  expenditures  of  the  Bureau  of  Deportation  represented 
substantially  the  total  expense  to  New  York  State  in  1912  in 
removing  these  alien  and  nonresident  insane  from  its  borders, 
the  per  capita  net  cost  of  removal  of  each  insane  alien  or  non- 
resident from  all  institutions  during  that  year  would  be  $26.77, 
which  is  the  result  reached  by  dividing  $46,939.24,  the  total  ex- 
penditure, by  1,753  the  total  number  of  aliens  and  nonresidents 
sent  away.  Doubtless  $26.77  is  more  than  the  average  cost  of 
removing  an  insane  nonresident  from  this  State  and  less  than  the 
average  cost  of  repatriating  an  insane  alien  but  the  exact  difference 
has  not  been  computed.  No  statistics  are  available  from  which  the 
exact  cost  of  removing  each  class  can  be  determined. 

In  1912  the  total  net  cost  to  New  York  State  for  the  average 
alien  patient  in  the  civil  hospitals  was  $279.18.  If  from  this 
is  deducted  $26.77,  the  estimated  average  per  capita  net  cost  of 
removing  alien  insane  from  the  'State  in  the  same  year,  the  result  is 
$252.41,  which  indicates  the  rate  of  saving  to  the  State  in  total 
net  cost  for  the  first  year  on  every  alien  deported  or  repatriated 
in  1912. 

On  this  basis  the  'State  saved  for  the  first  year  in  total  net 
cost  $295,572.11  on  the  1,171  aliens  removed  from  the  State  in 
1912.  Figured  on  the  same  basis  the  saving  to  the  State  for 
the  first  year  in  net  cost  on  the  582  nonresidents  returned  from 
the  State  in  1912  would  be  $146,902.62,  making  a  total  saving 
for  the  first  year  on  the  1,753  aliens  and  nonresidents  removed 
in  1912  of  $442,474.73.  Assuming  that  each  of  these  1,171  aliens 
lived  out  his  average  hospital  residence  in  the  civil  hospitals  of 
9.85  years,  the  total  saving  would  be  the  present  worth  of  the 
State's  yearly  contributions  for  the  support  of  these  patients  for 
such  period  less  the  cost  of  removal.  On  a  4  per  cent  basis  the 
present  worth  of  $1  paid  each  year  for  9.85  years,  according  to 
standard  monetary  tables,  is  $8.00956.  Accordingly  the  present 
worth  of  $279.18,  the  yearly  net  cost  to  the  State  of  the  average 
insane  alien,  paid  annually  for  9.85  years  would  amount  to  $2,- 
236.11.  Deducting  from  this  amount  $26.77,  the  average  cost  of 
removing  an  insane  alien,  the  remainder  is  $2,209.34,  which  is  the 


44     ALIEN  INSANE  IN  CIVIL  HOSPITALS  OF  NEW  YORK  STATE 

net  saving  to  the  State  resulting  from  the  removal  of  each  insane 
alien  in  1912.  If  this  $2,209.34:  is  multiplied  by  1,171,  the  num- 
ber of  insane  aliens  removed  from  the  State  in  1912,  the  product 
would  be  $2,587,137.14,  the  total  saving  in  net  cost  to  the 
State  from  the  removal  of  such  insane  aliens.  On  the  same  basis 
the  total  saving  in  net  cost  of  the  582  nonresidents  returned  in 
1912  would  be  $1,285,835.02,  making  a  grand  total  of  $3,872,- 
973.02. 

As  the  per  capita  expenditure  increases  from  year  to  year 
these  rates  of  saving  will  increase  correspondingly. 

According  to  the  foregoing  computations,  for  each  $1  expended 
by  New  York  State  in  1912  in  removing  alien  and  nonresident 
insane  from  its  borders,  the  total  savings  in  net  cost  for  the  first 
year  was  $9.43  and  for  the  patient  average  hospital  residence 
(9.85  years)  amounted  to  $82.51. 

The  following  is  a  summary  of  the  foregoing: 

SUMMARY  OF  SAVING  TO  NEW  YORK  STATE  FROM  REMOVAL  OF 
ALIEN  AND  NONRESIDENT  INSANE  IN  1912 

Average  per  capita  cost  of  removal  of  an  alien 

or  nonresident  insane  patient  in  1912 $26  77 

Per  capita  rate  of  saving  per  annum  in  net  cost 
for  each  alien  or  nonresident  removed  in 
1912 252  41 

Total  saving  for  the  first  year  in  net  cost  from 

removal  of  582  nonresident  insane  in  1912.  .  146,902   62 

Total  saving  for  the  first  year  in  net  cost  from 

removal  of  1,171  alien  insane  in  1912 295,572  11 

Total  saving  for  the  first  year  in  net  cost  from 
removal  of  1,753  alien  and  nonresident  in- 
sane in  1912  442,474  73 

Total  saving  in  net  cost  resulting  from  removal 
of  582  nonresident  insane  in  1912,  based  on 
average  hospital  residence  of  9.85  years.  .  .  .  1,285,835  02 

Total  saving  in  net  cost  resulting  from  removal 
of  1,171  alien  insane  in  1912,  based  on  aver- 
age hospital  residence  of  9.85  years 2,587,137  14 

Total  saving  in  net  cost  resulting  from  removal 
of  1,753  alien  and  nonresident  insane  in 


REPORT  OF  SPECIAL  COMMISSIONER  45 

1912,  based  on  average  hospital  residence  of 

9.85  years $3,872,973  02 

Total  saving  in  net  cost  for  the  first  year  for 

each    $1    expended   by    New   York    State    in 

1912  in  removing  alien  and  nonresident  in- 
sane    9  43 

Total  saving  in  net  cost  for  average  hospital 

residence  of  9.85  years  for  each  $1  expended 

by  New  York  State  in  1912  in  removing  alien 

and  nonresident  insane  .  82  51 


The  total  number  of  alien  and  nonresident  insane  removed 
from  the  State  in  1913  by  the  Bureau  of  Deportation  was  1,352 
on  a  total  expenditure  of  $59,184.14-,  as  against  1,753  in  1912 
for  a  total  expenditure  of  $46,939.24,  making  the  per  capita  cost 
of  removal  $43.78  in  1913  as  against  $26.77  in  1912,  a  per 
capita  increase  in  the  cost  of  removal  of  $17.01,  or  63.54  per 
cent. 

It  is  obvious  that  as  the  per  capita  cost  of  removal  increases 
the  saving  resulting  from  the  removal  of  the  alien  and  nonresi- 
dent insane  decreases  and  vice  versa. 

The  total  estimated  capacity  of  the  fourteen  civil  'State  hos- 
pitals for  the  insane  on  September  30,  1912,  as  certified  by  the 
various  hospital  superintendents,  was  26,753.  The  total  popu- 
lation was  31,624,  and  the  over-crowding  was  4,871.  The  number 
of  aliens  on  that  date  was  9,241. 

If  there  had  been  no  aliens  in  our  insane  hospitals  on  Sep- 
tember 30,  1912,  instead  of  being  over-crowded  by  upwards  of 
18  per  cent,  the  hospitals  would  have  had  vacant  over  16  per  cent 
of  their  capacity  or  room  for  4,370  additional  patients.  This 
would  care  for  the  increase  of  our  citizen  (native-born  and 
naturalized)  insane  population  for  years  to  come  and  would 
obviate  the  present  necessity  of  increasing  our  hospital  accommo- 
dations. 

It  is  wholly  unlikely  that  the  per  capita  cost  per  annum  of 
the  insane  will  decrease ;  on  the  contrary  there  is  every  likelihood 
that  it  will  increase.  In  1913  the  per  capita  gross  cost  of  main- 
tenance was  $206.08,  an  increase  of  $2.63  over  1912.  Heavy  as 


4-6     ALIEN  INSANE  IN  CIVIL  HOSPITALS  OF  NEW  YORK  STATE 

the  State  finds  the  financial  burden  of  the  alien  insane,  there  is 
every  reason  to  believe  that  it  will  become  still  heavier  year  by 
year  unless  immediate  steps  are  taken  to  remove,  so  far  as  possible, 
the  causes  of  present  conditions. 


IX.  SOME  OF  THE  CAUSES  OF  EXISTING 
CONDITIONS 

RELATION.  OF  THE  STATE  TO  THE  UNITED  STATES 

The  fundamental  reason  for  the  existence  of  the  problem  of 
the  alien  insane  is  the  helpless  position  of  New  York  and  the 
other  states,  under  present  law,  as  to  the  admission  and  expulsion 
of  aliens. 

The  State  has  no  jurisdiction  over  immigration,  other  than 
that  incident  to  the  exercise  of  its  police  power,  and  has  neither 
the  right  to  prevent  undesirable  aliens  from  coming  within  its 
borders  nor  authority  to  remove  them  therefrom  once  they  have 
entered.  The  power  to  regulate  immigration  is  vested  in  the 
Federal  government  alone,  which  by  its  laws  and  rules  determines 
what  aliens  shall  be  admitted  to  or  removed  from  the  several 
states.  If  a  State  suffer  wrong  or  hardship  by  reason  of  the 
operation  of  these  laws  and  rules  it  can  obtain  no  adequate  relief 
through  the  exercise  of  its  own  law  making  powers. 

The  State,  therefore,  not  only  must  receive  within  its  borders 
all  such  aliens  as  the  United  States  admits  thereto,  but  must 
apply  to  the  Federal  authorities  to  remove  therefrom  any  aliens 
it  may  find  to  be  undesirable,  for  it  cannot  of  its  own  right  re- 
move any  of  them  against  his  will. 

As  bearing  upon  the  problem  of  the  alien  insane  the  United 
States  Immigration  Act  is  all  important.  Section  2  of  the  act 
excludes  from  admission  into  the  United  States  certain  classes, 
among  those  named  being  idiots,  imbeciles,  feeble-minded  per- 
sons, epileptics  and  insane  persons.  Section  20,  which  provides 
for  the  deportation  of  aliens,  permits  deportation  of  but  two 
classes,  those  "  who  shall  enter  the  United  States  in  violation  of 
law  "  and  "  such  as  become  public  charges  from  causes  existing 
prior  to  landing  "  but  neither  class  may  be  deported  except  "  within 
three  years  after  *  *  *  entry  into  the  United  States." 


REPORT  OF   SPECIAL  COMMISSIONS  47 

If  then  the  Federal  government  admits  within  the  State  of  New 
York  an  alien  who  thereafter  becomes  insane,  the  Immigration 
Act  forbids  (in  that  it  does  not  permit)  his  deportation  except 
within  three  years  from  the  date  of  his  entry  into  this  country 
and  then  only  if  the  alien  has  entered  the  United  States  in  vio- 
lation of  law  or  has  become  a  public  charge  from  causes  existing 
prior  to  landing. 

After  the  three  year  period  has  expired  the  State  may  rid  itself 
only  of  such  insane  aliens  as  go  without  objecting.  Of  the 
total  number  of  those  who  thus  left  New  York  State  from  1905 
to  1913  inclusive,  more  than  one-half  were  sent  home  at  the  ex- 
pense of  the  State. 

Although  it  takes  five  years  for  the  alien  to  become  a  citizen, 
nevertheless  the  alien,  by  being  three  years  within  a  State, 
neither  desiring  nor  intending  to  become  a  citizen,  at  no  time 
contributing  by  the  payment  of  direct  taxes  to  the  support  of  the 
commonwealth  and  being  unavailable  for  the  military  or  civil 
duties  of  a  citizen,  may,  if  he  becomes  insane,  by  operation  of 
the  Immigration  Act,  acquire  such  rights  as  against  the  State  that 
it  is  powerless  to  expel  him  from  its  boundaries  or  to  compel  his 
return  to  the  country  of  which  he  is  a  citizen  but,  for  its  public 
safety  and  welfare  or  :  from  humanitarian  motives,  must  care  for 
and  maintain  him  so  long  as  he  chooses  to  remain. 

THE  BURDEN  OF   THE  ALIEN   INSANE  is   IMPROPERLY   PLACED 
AND  is  BORNE  UNEQUALLY 

Under  the  Immigration  Act  not  only  is  the  individual  State 
without  power  to  prevent  the  entry  of  undesirable  aliens  or  to 
compel  the  expulsion  of  aliens  who  become  insane  but,  because 
of  the  immigration  rules,  the  financial  burden  of  the  alien  insane 
is  cast  upon  the  several  States  and  not  upon  the  United  States.  It 
might  not  make  so  much  difference,  in  one  aspect  of  the  case,  if 
this  burden  were  equally  distributed  among  all  the  States,  but 
the  facts  of  this  report  show  that  New  York  State  has  far  more 
than  its  proper  share  of  the  alien  insane  and  sustains  a  propor- 
tionately larger  part  of  the  resultant  cost.  That  this  burden  is 
likely  to  continue  to  be  disproportionate  is  evidenced  by  the  fact 
that  of  the  838,172  immigrants  arriving  in  the  fiscal  year  ending 


48     ALIEN  INSAXE  ix  CIVIL  HOSPITALS  OF  NEW  YORK  STATE 

June  30,  1912,  239,275,  or  28.5  per  cent,  were  destined  to  New 
York  State. 

'Since  jurisdiction  over  immigration  is  vested  in  the  Federal 
government  alone,  it  is  but  equitable  that  the  nation  as  a  whole 
and  not  some  few  of  the  several  states  should  bear  the  burden 
incident  to  the  exercise  thereof.  If  the  United  States,  for  humane 
or  other  reasons,  elects  to  retain  within  its  borders  as  public 
charges  insane  persons  who  have  never  acquired  the  rights  nor 
assumed  the  duties  of  citizenship  it  is  but  common  justice  that 
it  and  not  a  small  minority  of  the  states  should  provide  the  re- 
quisite care  and  maintenance. 

A  careful  examination  of  the  Immigration  Act  reveals  no  pro- 
vision for  payment  for  the  maintenance  of  aliens  who  "  become 
public  charges  from  causes  existing  prior  to  landing  "  in  which 
category  are  most  of  the  aliens  deported  under  Federal  warrant. 

The  only  portions  of  the  act  touching  upon  expenses  connected 
with  the  alien  insane  are  found  in  sections  19  and  20. 

•Section  19  of  the  act  directs  the  immediate  return  of  all  aliens 
brought  to  this  country  in  violation  of  law  and  charges  their 
maintenance  while  on  land  and  the  expense  of  their  return  to  the 
owners  of  the  vessels  on  which  they  came  and  also  permits  an 
insane  alien,  whose  health  or  safety  would  be  unduly  imperiled 
by  immediate  deportation,  to  be  held  for  treatment  at  the  expense 
of  the  "  immigrant  fund  "  until  such  time  as  he  may  be  safely 
deported. 

Section  20  provides  for  the  payment  of  the  expense  of  remov- 
ing to  the  port  of  deportation  and  transporting  thence  the  alien 
for  whose  deportation  the  Secretary  of  Labor  has  issued  a 
warrant. 

The  Immigration  Act,  therefore,  while  imposing  upon  the 
United  States,  by  section  20,  the  duty  of  deporting  aliens  who 
become  "  public  charges  from  causes  existing  prior  to  landing " 
in  order  that  they  shall  not  continue  to  be  "  public  charges," 
falls  entirely  to  provide  for  the  discharge  of  the  financial  obliga- 
tion necessarily  arising  in  connection  with  the  full  performance 
of  that  duty. 

In  actual  practice  in  the  past  the  matter  has  been  governed  by 
the  immigration  rules  under  authority  of  section  22  of  the  Im- 
migration Act. 


REPOUT  OF  SPECIAL  COMMISSIONER  49 

At  one  time  the  government,  very  properly,  reimbursed  the 
State  from  the  day  the  deportable  alien  was  admitted  into  a  'State 
hospital  —  the  day  when  he  became  a  "public  charge."  By  suc- 
cessive modifications,  each  resulting  in  lesser  payments  to  the 
State,  the  irreducible  minimum  appeared  to  have  been  reached  in 
the  present  subdivision  7  of  Rule  22  of  the  immigration  rules 
which,  so  far  as  pertinent,  reads: 

"Subd.  7.  Cost  of  maintenance  pending  deportation  on 
warrant. —  The  cost  of  maintaining  aliens  during  these  pro- 
ceedings may  be  borne  by  the  Government,  but  as  to  aliens 
who  have  become  public  charges  from  causes  existing  prior 
to  landing,  such  cost  will  be  allowed  only  for  the  period 
subsequent  to  the  date  of  issuance  of  warrant  of  arrest,  and 
then  only  in  case  this  is  followed  by  an  order  of  deportation. 
Maintenance  bills  under  this  rule  shall  be  delivered  to  the 
immigration  officer  in  immediate  charge  of  the  case  within 
twenty  days  from  the  close  of  the  calendar  month  in  which 
occurs  the  death  of  the  alien  or  removal  from  the  institution 
for  deportation,  and  failure  so  to  render  them  shall  relieve 
the  United  States  from  any  responsibility  for  the  payment 
thereof." 

"  The  period  subsequent  to  the  date  of  the  issuance  of  warrant 
of  arrest "  for  which  the  government  would  reimburse  the  State 
under  the  above  rule  is  sometimes  but  a  matter  of  a  few  days  but 
in  no  instance  represents  the  entire  time  during  which  the  de- 
portable  alien  has  been  a  "  public  charge "  of  the  'State.  It 
should  further  be  noted  that  under  the  rule  no  allowance  is  made 
to  the  State  unless  the  warrant  of  arrest  is  followed  by  an  order 
of  depOTtation. 

The  report  of  the  Bureau  of  Deportation  for  1913  states  that  in 
practice  the  reimbursement  is  even  smaller  than  that  prescribed  in 
the  rule,  as  maintenance  charges  are  now  allowed  only  from  the 
date  of  the  service  (not  of  the  issuance)  of  the  warrant  until  the 
date  of  removal  of  the  insane  alien  from  the  institution  by  the 
government  officials.  It  is  also  stated  therein  that  in  cases  where 
warrants  of  arrest  have  actually  been  issued  and  the  deportable 
aliens  have  died  in  the  hospitals  before  their  deportation  could 


r.o     ALIEN  INSANE  IN  CIVIL  HOSPITALS  or  NEW  YORK  STATE 

be  effected  the  government  has  refused  to  pay  the  maintenance 
charges. 

Under  date  of  December  24,  1913  the  Acting  Commissioner  of 
Immigration  at  Ellis  Island  notified  the  New  York  State  authori- 
ties that  the  .Secretary  of  Labor  had  suspended  that  portion  of  sub- 
division 7  Rule  22  ik  which  relates  to  the  maintenance  of  aliens 
who  become  public  charges  from  causes  existing  prior  to  landing, 
such  suspension  to  become  effective  December  31,  1913,  after 
which  date  maintenance  bills  for  the  care  of  alien  public  charges 
will  not  be  paid  by  the  Government."  The  necessity  for  the  sus- 
pension is  stated  in  the  letter  of  notification  to  be  "  the  fact  that 
Congress  has  not  sufficiently  provided  for  the  maintenance  and 
upkeep  of  the  Immigration  Service  during  the  current  fiscal  year 
and  vigorous  retrenchment  is  essential."  The  final  statement  in 
the  letter  is  "  There  is  no  requirement  of  law  which  obligates  the 
Government  to  pay  these  bills  and  the  only  remedy  for  the  situa- 
tion lies  in  an  increased  appropriation  by  Congress." 

For  the  year  ending  September  30,  1913  the  Federal  govern- 
ment paid  New  York  State  $8,290.57  for  care  and  maintenance  of 
insane  aliens  and  at  the  end  of  the  year  owed  the  State  for  the 
same  purposes  $1,594.43  additional,  a  total  of  $9,885.  In  con- 
trast with  the  net  cost  of  the  alien  insane  to  the  State  of  New 
York  in  1912  amounting  to  $2,579,902.38,  this  $9,885  seems  in- 
significant. 

In  the  past  the  State  of  New  York  has  expended  annually  very 
large  sums  of  money  upon  the  alien  insane  which  of  right  should 
have  been  paid  by  the  Federal  government  and  to  the  repayment 
of  which  it  is  equitably  entitled.  But  whether  or  not  recompense 
is  had  for  the  past,  justice  should  be  done  in  the  future  and  the 
United  States  should  assume  the  cost  of  the  care  and  mainten- 
ance of  deportable  aliens  from  the  time  they  become  public 
charges. 

Originally  when  the  State  of  New  York  supervised  immigration 
at  the  Port  of  New  York  the  State  collected  a  head  tax.  Now, 
pursuant  to  section  1  of  the  Immigration  Act,  the  Federal  govern- 
ment collects  a  head  tax  of  $4  upon  every  alien  entering  the 
United  States.  In  view  of  these  facts  the  government's  failure 
to  reimburse  the  State  of  New  York  for  the  care  and  maintenance 


REPORT  OF  SPECIAL  COMMISSIONER  51 

of  the  deportable  insane  aliens  is  both  inconsistent  and  unjustifi- 
able. 

The  more  serious  aspect  of  the  situation,  however,  is  that  the 
Federal  government  is  not  made  to  feel  its  obligations.  When 
the  United  States  is  made  to  bear  its  proper  share  of  the  financial 
burden  of  the  alien  insane  its  laws,  rules  and  efforts  in  excluding 
and  deporting  mentally  diseased  and  defective  aliens  will  become 
correspondingly  more  efficient. 

It  is  interesting  to  note  in  connection  with  this  matter  of  the 
reimbursement  for  care  and  maintenance  of  the  insane  aliens  that 
the  government  acts  quite  differently  in  respect  to  an  alien  "  who 
is  a  lawful  resident  of  the  United  States  and  who  has  become  a 
public  charge  from  physical  disability  arising  subsequent  to  land- 
ing/' who  is  deported  with  his  consent  and  the  approval  of  the 
government.  Under  Rule  24  such  an  alien  may  be  deported 
within  one  year  from  landing  at  the  expense  of  the  United  States 
and  "  the  charges  incurred  for  his  care  and  treatment  in  any 
public  or  charitable  institution  from  the  date  of  notification  to 
an  immigration  official  until  the  expiration  of  one  year  after  land- 
ing may  be  paid  by  the  Bureau  at  such  rates  as  it  shall  accept  as 
reasonable." 

The  justification  for  this  difference  in  attitude  is  not  readily 
apparent. 

DEFECT  OF  THE  IMMIGRATION  ACT  AS  TO   CLASSES  EXCLUDED 
Section  2  of  the  Immigration  Act  excludes  from  admission  to 
this  country  among  others  these  classes,  viz. : 

(1)  "  Idiots,   imbeciles,   feebleminded  persons,   epileptics 
and  insane  persons." 

(2)  "  Persons   who  have  been   insane   within   five  years 
previous." 

(3)  "  Persons  who  have  had  two  or  more  attacks  of  in- 
sanity at  any  time  previously." 

(4)  "  Persons  likely  to  become  a  public  charge." 

(5)  "  Persons  not  comprehended  within  any  of  the  fore- 
going excluded  classes  who  are  found  to  be  and  are  certified 
by  the  examining  surgeon  as  being  mentally  or  physically  de- 
fective,  such  mental  or  physical   defect  being  of  a  nature 
which  may  affect  the  ability  of  such  alien  to  earn  a  living." 


52     ALIEN  INSANE  IN  CIVIL  HOSPITALS  OF  NEW  YORK  STATE 

While  these  classes  include  all  of  the  mental  defectives  and  the 
insane;  they  do  not  include  two  classes  particularly  likely  to  be- 
come insane. 

Many  of  the  aliens  in  our  State  hospitals  became  insane  011 
account  of  chronic  alcoholism  and  many  more  of  them  evidenced 
constitutional  psychopathic  inferiority  before  becoming  insane. 
Yew,  if  any,  of  these  are  included  in  the  foregoing  classes. 

Moreover  persons  who  have  been  insane  at  any  time  previously 
should  be  excluded.  Further  the  exclusion  of  no  mentally  de- 
fective person  should  rest  upon  his  inability  to  earn  a  living  but 
the  exclusion  of  all  mentally  defective  persons  should  be  manda- 
tory. 

To  accomplish  these  changes  there  should  be  added  to  paragraph 
(1)  above  the  words  "  Persons  with  chronic  alcoholism,  persons 
with  constitutional  psychopathic  inferiority,  and  persons  who  have 
been  insane  at  any  time  previously." 

Paragraphs  (2)  and  (3)  as  above  numbered  should  be  stricken 
from  the  law  and  also  the  words  "  mental  or  "  in  paragraph  (5). 

TIME  LIMIT  UPON  DEPORTATION 

Section  20  of  the  Immigration  Act  provides  in  part  "  That  any 
alien  who  shall  enter  the  United  States  in  violation  of  law,  and 
such  as  become  public  charges  from  causes  existing  prior  to 
landing,  shall,  upon  the  warrant  of  the  Secretary  of  Labor,  be 
taken  into  custody  and  deported  to  the  country  whence  he  came 
at  any  time  within  three  years  after  the  date  of  his  entry  into 
the  United  States." 

Table  14  gives  the  length  of  time  within  the  United  States  be- 
fore admission  to  the  New  York  civil  hospitals  of  the  aliens  and 
patients  of  unascertained  citizenship,  numbering  in  all  15,985, 
among  the  first  admissions  for  the  eight  years  from  1905  to  1912 
inclusive. 

Assuming  that  the  time  in  this  country  before  admission  to 
the  State  hospitals  of  alien  patients  and  of  patients  whose  citizen- 
ship was  unascertained  was  relatively  the  same,  the  percentages 
for  the  various  time  divisions,  as  given  in  Table  14,  would  apply 
alike  to  aliens  and  patients  of  unascertained  citizenship.  It  ap- 
pears, therefore,  that  of  the  alien  first  admissions  for  the  eight 
years,  1905-12,  17.7  per  cent  entered  the  hospitals  within  three 


REPORT  OF  SPECIAL  COMMISSIONER  53 

years  after  landing  in  the  United  States,  9.3  per  cent  entered 
after  being  here  three  years  but  less  than  five  years  and  64.3  per 
cent  after  having  been  in  this  country  more  than  five  years.  The 
time  prior  to  admission  of  8.7  per  cent  of  the  aliens  could  not'  be 
ascertained.  Assuming  the  time  of  the  unascertained  cases  in 
the  United  States  before  admission  to  be  relatively  the  same  as 
that  of  the  known  cases  the  percentages  would  be  changed  as 
follows : 

Per  cent 
Aliens  admitted  within  three  years  after  entering  the 

United  States 19.4 

Aliens  admitted  more  than  three  years  but  within 

five  years  after  entering  the  United  -States 10.2 

Aliens  admitted  more  than  five  years  after  entering 

the  United  States  .  70.4 


From  the  latter  figures  it  is  apparent  that  under  the  present 
time  limit  upon  deportation  of  three  years  as  fixed  by  the  Immigra- 
tion Act,  JSTew  York  State  cannot  expect  more  than  19.4  per  cent 
of  the  alien  first  admissions  to  the  civil  hospitals  to  come  within 
the  limit,  leaving  80.6  per  cent  non  deport  able,  while  if  the  deporta- 
tion period  be  extended  to  five  years  29.6  per  cent  of  the  alien 
first  admisssions  would  be  included  leaving  70.4  per  cent  who 
would  not  be  subject  to  deportation. 

It  should  also  be  noted  that  not  all  the  insane  aliens  who  enter 
the  ^s"ew  York  civil  hospitals  as  public  charges  within  three  years 
after  their  entry  into  this  country  are  deportable,  as  the  causes  of 
the  insanity  of  all  of  them  either  did  not  exist  prior  to  such  entry 
or  cannot  be  proved  to  have  so  existed. 

From  the  foregoing  calculations  it  will  readily  be  seen  that  the 
three-year  limit  upon  deportation  is  wholly  inadequate  and  that 
the  substitution  of  a  five-year  limit  would  likewise  be  insufficient, 
since  even  with  the  latter  limit  more  than  seven-tenths  of  the 
alien  insane  first  admissions  to  the  ISTew  York  hospitals  from  1905 
to  1912  inclusive  could  not  legally  have  been  deported. 

The  shorter  the  time  limit  upon  deportation  the  larger  will 
be  the  number  of  the  alien  insane  remaining  in  our  hospitals. 

From  the  purely  logical  standpoint  there  is  no  reason  why  there 


54     ALIEN  INSANE  IN  CIVIL  HOSPITALS  OF  NEW  YORK  STATE 

should  be  any  time  limit  upon  the  deportation  of  the  alien  insane, 
as  the  State  should  care  for  and  maintain  none  but  its  own  in- 
digent citizen  insane. 

DEFECT  OF  THE  IMMIGRATION  ACT  AS  TO  "  PUBLIC  CHARGES  " 

Under  section  20  of  the  Immigration  Act,  above  quoted,  but  two 
classes  of  insane  aliens  are  deportable  —  those  "  who  shall  enter 
the  United  States  in  violation  of  law  "  and  "  such  as  become 
public  charges  from  causes  existing  prior  to  landing." 

Even  though  the  alien  becomes  insane  from  causes  existing 
prior  to  landing  he  is  not  deportable  unless  he  becomes  a  public 
charge,  provided  his  entry  into  the  United  States  was  legal. 

Thus  the  law  makes  a  distinction  in  favor  of  the  insane  alien 
who  commands  resources  sufficient  to  keep  him  from  becoming  a 
public  charge  as  against  the  insane  alien  who  has  no  funds  at  his 
command,  though  the  former  is  no  more  useful  or  desirable  an 
individual  than  the  latter.  From  the  eugenic  point  of  view  they 
represent  equal  possibilities  of  ill  for  the  generations  to  follow. 
According  to  the  theory  of  the  law  the  insane  alien  is  no  menace 
unless  and  until  he  becomes  a  public  charge. 

In  operation  the  law  is  as  defective  as  in  theory.  Under  its 
provisions  it  is  necessary  only  for  the  relatives  or  friends  of  an 
alien  who  becomes  insane  from  prior  causes  within  the  three-year 
period  to  prevent  his  becoming  a  public  charge  before  the  three 
years  have  expired.  After  that  time  not  only  is  it  impossible  to 
send  the  alien  home  without  his  consent,  but  the  State  must  care 
for  and  maintain  him. 

PROVISION  OF  THE  IMMIGRATION  ACT  AS  TO  "  CAUSES  EXISTING 
PRIOR  TO  LANDING  " 

According  to  section  20  of  the  Immigration  Act  the  insane  alien 
who  is  a  public  charge  can  be  deported  only  if  his  insanity  arose 
"  from  causes  existing  prior  to  landing."  He  cannot  be  deported 
if  the  causes  of  his  psychosis  arose  subsequent  to  his  landing.  As 
to  prior  causes  the  government  disclaims  responsibility ;  of  subse- 
quent causes  it  puts  the  burden  upon  the  states. 

The  causation  of  insanity  is  at  best  a  difficult  and  intricate  sub- 
ject. Theoretically  causation  should  not  enter  into  the  question. 


KEPOKT  OF  SPECIAL  COMMISSION EK  55 

but  if  the  causes  of  insanity  are  to  continue  to  be  determining 
factors  in  deportation,  the  Immigration  Act  should  be  amended  so 
as  to  provide  that  an  alien  becoming  insane  may  be  deported  un- 
less the  causes  of  his  insanity  arose  subsequent  to  his  entry  into 
this  country. 

If  any  extrinsic  facts  are  needed  to  prove  the  existence  of  the 
causes  of  the  alien's  insanity  prior  to  his  landing  they  cannot  be 
obtained  in  this  country  as  readily  as  in  the  country  from  wh'ich 
the  alien  migrated,  while  the  facts  establishing  causes  arising 
subsequent  to  his  landing  should  be  obtainable  here,  if  anywhere. 

The  law,  moreover,  places  the  burden  of  proof  as  to  the  causation 
of  the  alien's  insanity  upon  the  'State  and  not  upon  the  alien.  If 
the  State  fails  to  establish  that  the  alien's  insanity  arose  from 
"  causes  existing  prior  to  landing  "  the  alien  escapes  deportation. 

This  is  emphasized  by  subdivision  3  of  Rule  22  of  the  Depart- 
ment of  Labor,  Bureau  of  Immigration,  relating  to  the  facts  to  be 
set  forth  in  the  medical  certificate  essential  in  deportation,  of 
which  paragraph  (d)  requires  proof  as  to  "  Whether  the  causes 
which  render  the  alien  a  public  charge  existed  prior  to  landing  or 
arose  subsequent  thereto,  and  in  the  former  case  the  reasons  in  de- 
tail justifying  such  a  conclusion." 

Placing  this  burden  of  proof  upon  the  State  is  but  the  grant  by 
the  Federal  government  to  an  insane  alien  of  an  additional  right  as 
against  the  State  and,  in  practice,  inflicts  a  considerable  hardship. 

"  DECISION  No.  120  " 

Although  the  law  and  immigration  rules  make  it  difficult  for  the 
State  of  New  York  to  rid  itself  of  undesirable  aliens,  yet  the  rule 
promulgated  by  the  late  Department  of  Commerce  and  Labor  and 
commonly  known  as  "  Decision  No.  120,"  greatly  increases  the 
difficulty. 

This  decision  was  rendered  by  a  solicitor  of  the  Department  of 
Commerce  and  Labor,  January  11,  1912,  and  was  later  (February 
3,  1912)  approved  by  the  Attorney-General. 

The  history  of  this  decision  may  be  found  in  the  report  of  the 
Bureau  of  Deportation  for  the  year  ending  September  30,  1912. 

In  substance  the  decision  amounts  to  an  assertion  of  the  propo- 
sition that  medical  and  other  examinations  of  an  insane  alien. 


56     ALIEN  INSANE  IN  CIVIL  HOSPITALS  OF  NEW  YORK  STATE 

opinions  of  qualified  alienists  and  recommendations  of  the  Com- 
missioner of  Immigration  are  valueless  unless  accompanied  by 
some  affirmative  facts  which  would  prove  to  a  lay  mind  that  the 
cause  of  the  alien's  insanity  existed  prior  to  landing. 
.  Even  if  a  medical  opinion  is  as  stated  in  "  Decision  No.  120  " 
"  wholly  ex  post  facto  "  it  should  not  be  rejected  upon  that  ground 
alone.  If  the  author  of  the  opinion  possesses  the  requisite  quali- 
fications and  the  opinion  is  given  in  a  proper  case  due  weight 
should  be  attached  to  it. 

Much  medical  opinion  must  necessarily  be  of  a  nature  "  wholly 
ex  post  facto." 

It  is  no  "  bald  medical  opinion,"  to  use  a  phrase  of  the  decision, 
to  assert  that  the  paretic  must  have  suffered  from  syphilis  some 
years  prior  to  his  insanity,  though  no  present  evidence  of  the  phys- 
ical disease  appears ;  on  the  contrary  it  is  a  sound  medical  opinion 
based  upon  experience,  observation  and  study.  In  the  case  of 
typhoid  fever,  for  example,  the  symptoms  of  the  disease  prove  "  ex 
post  facto  "  that  there  must  have  been  a  prior  entrance  of  the 
typhoid  bacillus  into  the  body  of  the  patient. 

To  entitle  it  to  reception  as  a  precedent  and  authority  "  De- 
cision No.  120  "  should  have  gone  further  than  it  did  and  shown 
father  that  the  alienists  were  incompetent  to  express  the  opinions  in 
question  or  that  the  psychosis  from  which  the  patient  suffered 
was  one  wherein  an  opinion  "  wholly  ex  post  facto  "  was  of  no 
value.  In  the  latter  case  "  Decision  No.  120  "  might  properly 
serve  as  a  precedent  until  such  time  as  psychiatry  could  demon- 
strate that  medical  opinion  "  wholly  ex  post  facto  "  could  be  relied 
upon  as  to  the  priority  of  the  causation  of  the  particular  psychosis. 

"Decision  No.  120"  cannot,  however,  be  upheld  upon  the 
ground  that  an  opinion  "  wholly  ex  post  facto  "  was  of  no  value  in 
that  particular  case.  The  mental  disease  under  consideration 
therein  was  manic-depressive  insanity,  the  primary  cause  of  which 
is  a  fundamental  defect.  This  cause  was  very  properly  termed 
by  the  examining  physicians  "  constitutional  psychopathic  ten- 
dencies and  mental  instability." 

It  must  be  readily  apparent  that  in  the  cases  of  many  insane 
aliens  the  "  affirmative  fact,"  made  essential  by  "  Decision  No. 
120  "  to  prove  the  prior  existence  of  the  insanity,  is  unprocurable. 


KEPORT  OF  SPECIAL  COMMISSIONER  57 

In  such  instances  in  addition  to  assuming  the  burden  of  proof  the 
State,  by  virtue  of  "  Decision  No.  120,"  must  labor  under  an  im- 
proper rule  as  to  the  weight  of  evidence. 

The  immediate  result  of  "  Decision  No.  120  "  was  not  only  that 
the  State  was  unable  to  deport  the  insane  alien  in  whose  case  the 
opinion  was  rendered  (more  than  18  months  later  she  was  still  an 
inmate  of  a  New  York  institution)  but  a  larger  number  of  war- 
rants of  arrest  for  deportation  in  other  cases  were  cancelled  by  the 
Department  of  Commerce  and  Labor.  These  cancellations  num- 
bered 36  in  1911  and  80  in  1912.  To  "  Decision  No.  120  "  the 
Bureau  of  Deportation  of  New  York  State  attributed  to  a  great 
extent  this  increase. 

The  effect  of  and  any  necessity  for  "  Decision  No.  120  "  would 
disappear  if,  as  suggested,  the  Immigration  Act  permitted  the 
deportation  of  an  insane  alien  unless  it  be  shown  that  the  causes 
of  his  insanity  arose  subsequent  to  landing. 

Even  if  this  suggested  amendment  is  not  immediately  enacted, 
it  is  hoped  that  the  present  Department  of  Labor,  as  the  result  of 
riper  experience  in  the  science  of  psychiatry,  will  see  fit  in 
cases  of  deportation  to  give  to  the  certificates  of  competent  alien- 
ists, the  same  probative  force  which  section  10  of  the  Immigration 
Law  itself  declares  they  shall  have  when  the  question  of  exclusion 
is  involved. 

CANCELLATION  OF  WARRANTS  OF  ARREST  FOR  DEPORTATION 

From  the  reports  of  the  New  York  State  Commission  in 
Lunacy,  now  the  State  Hospital  Commission,  for  the  years  1910 
to  1912  inclusive,  it  appears  that  the  then  Department  of  Com- 
merce and  Labor  cancelled,  in  1910,  12  warrants  of  arrest  for 
deportation  obtained  by  the  New  York  State  authorities,  36  in 
1911  and  80  in  1912,  an  increase  of  566  per  cent  in  three  years. 

In  the  majority  of  all  these  cancellations  the  officers  of  the 
United  States  Public  Health  'Service  and  the  lay  immigrant  in- 
spectors concurred  in  the  opinions  of  the  New  York  State  alien- 
ists as  to  the  deportability  of  the  insane  aliens, 

As  section  21  of  the  Immigration  Act  required  the  Secretary 
of  Commerce  and  Labor  to  deport  an  alien  if  satisfied  that  the 
alien  is  subject  to  deportation,  it  is  evident  that  in  more  than  50 


58     ALIEN  INSANE  IN  CIVIL  HOSPITALS  OF  NEW  YORK  STATE 

per  cent  of  the  cancellations  expert  medical  opinion  failed  to 
satisfy  the  Department  of  Commerce  and  Labor.  This  indicates  a 
radical  difference  of  opinion  between  the  lay  and  medical  minds 
which  is  of  very  large  moment  to  New  York  and  other  states. 

If  "  Decision  No.  120  "  is  typical  of  the  grounds  taken  in  can- 
celling warrants  of  arrest  it  is  sincerely  to  be  hoped  that  the  pres- 
ent Department  of  Labor  will  not  follow  the  precedents  of  its 
predecessor,  the  Department  of  Commerce  and  Labor. 

To  cancel  even  one  warrant  of  arrest  is  a  serious  matter,  both 
in  its  eugenic  and  financial  aspects;  to  nullify  128  warrants  in 
three  years,  and  in  rapidly  increasing  numbers,  is  so  grave  in 
its  possibilities  as  to  call  for  immediate  inquiry  into  its  justifi- 
cation, and  speedy  correction,  if  unjustified. 

Under  subdivision  4  of  Rule  22  of  the  Immigration  Rules,  the 
alien  for  whom  a  warrant  of  arrest  for  deportation  has  been 
issued,  is  granted  a  hearing,  allowed  to  inspect  the  warrant  and 
all  the  evidence  on  which  it  was  issued,  to  be  represented  by 
counsel  and  to  offer  evidence.  It  is  but  fair  and  proper  there- 
fore that  in  every  case  where  there  is  any  question  as  to  the  de- 
portability  of  an  insane  alien  the  State  be  properly  represented, 
hear  all  the  evidence  offered  in  behalf  of  the  "alien  and  be  given 
a  reasonable  opportunity  to  present  evidence  in  rebuttal.  If  the 
evidence  of  the  State  is  deemed  insufficient  to  warrant  deportation 
the  State  should  have-  the  right  not  only  to  present  additional  evi- 
dence but  also  to  examine  any  evidence  submitted  on  behalf  of 
the  insane  alien.  It  is  credibly  asserted  that  in  the  past  these 
rights  have  at  times  been  denied  the  State. 

ACCEPTANCE  OF  BONDS 

Section  26  of  the  Immigration  Act,  permitting  the  landing  of 
aliens  under  bonds  is  as  follows: 

"  That  any  alien  liable  to  be  excluded  because  likely  to  be- 
come a  public  charge  or  because  of  physical  disability  other 
than  tuberculosis  or  a  loathsome  or  dangerous  contagious 
disease  may,  if  otherwise  admissible,  nevertheless  be  ad- 
mitted in  the  discretion  of  the  Secretary  of  Labor  upon  the 
giving  of  a  suitable  and  proper  bond  or  undertaking,  ap- 


REPORT  OF  SPECIAL  COMMISSIONER  50 

proved  by  said  Secretary  in  such  amount  and  containing 
such  conditions  as  he  may  prescribe,  to  the  people  of  the 
United  States,  holding  the  United  States  or  any  state,  terri- 
tory, county,  municipality,  or  district  thereof  harmless 
against  such  alien  'becoming  a  public  charge.  The  admission 
of  such  alien  shall  be  a  consideration  for  the  giving  of  such 
bond  or  undertaking.  Suit  may  be  brought  thereon  in  the 
name  and  by  the  proper  law  officers  either  of  the  United 
States  Government  or  of  any  state,  territory,  district,  county, 
or  municipality  in  which  such  alien  becomes  a  public  charge." 

Under  this  provision  of  law  it  is  asserted  that  aliens  afflicted 
with  insanity  have  been  admitted  to  the  State  of  New  York  under 
bond.  If  the  assertion  is  correct  the  aliens  were  admitted  in  viola- 
tion of  law  and  were  deportable  under  section  20  of  the  Immigra- 
tion Act. 

It  will  be  noticed  that  section  26  permits  the  two  following 
classes  of  aliens  to  be  admitted  under  bond,  viz:  Those  " liable 
to  be  excluded  because  likely  to  become  a  public  charge  or  because 
of  physical  disability  (other  than  tuberculosis  or  a  loathsome  or 
dangerous  contagious  disease)  if  otherwise  admissible." 

Under  section  2  of  the  act  "  insane  persons "  are  specifically 
"  excluded  from  admission  into  the  United  States"  as  are  "per- 
sons likely  to  become  a  public  charge."  Therefore  persons 
afflicted  with  insanity  are  not  "  otherwise  admissible "  in  the 
language  of  section  26  nor  could  they  by  any  construction  be 
embraced  within  the  meaning  of  the  words  "  likely  to  become  a 
public  charge"  in  section  26. 

Even  if  the  law  permitted  the  admission  of  insane  aliens  under 
bonds  it  would  be  a  most  unwise  and  dangerous  practice  from 
any  point  of  view. 

LACK    OF    SUFFICIENT    FUNDS    IN    THE    PAST    FOR    RETURN    OF 

THE  ALIEN  AND  NONRESIDENT  INSANE  BY  THE  STATE 

There  are  two  methods  by  which  insane  aliens  are  returned 

to  their  native  countries  from  the  State  of  Xew  York.     The  first, 

"  deportation,"  is  that  employed  where  the  insane  alien  is  sent 

back  by  the  United  States  government  pursuant  to  the  provisions 


GO     ALIEN  IK  SANE  IN  CIVIL  HOSPITALS  OF  NEW  YORK  STATE 

of  the  Immigration  Act.  In  deportation  the  expense  of  travel 
from  the  port  of  embarkation  is  borne  by  the  transportation  line 
by  which  the  alien  came  to  this  country.  The  second,  known  as 
"  repatriation,"  is  the  method  employed  by  the  State  for  returning 
insane  aliens  who  cannot  be  "  deported  "  under  the  provisions  of 
the  Federal  law.  All  expenses  connected  with  repatriation  are 
borne  either  by  the  State  or  by  the  repatriates,  their  relatives  or 
friends. 

The  work  of  repatriation  in  New  York  State  is  conducted  by 
the  Bureau,  of  Deportation  (which  prior  to  1912  was  known  as 
the  Board  of  Alienists)  under  the  supervision  of  the  State  Hos- 
pital Commission.  This  Bureau  also  assists  in  Federal  deporta- 
tions and,  among  other  duties,  attends  to  the  return  to  other 
states  of  the  nonresident  insane. 

During  the  past  three  years  the  State  of  New  York  has  re- 
patriated 1,677  insane  aliens  as  against  1,143  deported  from 
Xew  York  State  by  the  United  States  government  under  Federal 
warrant.  In  addition  during  the  same  period  the  State  has  re- 
turned 1,411  nonresident  insane  to  other  states.  The  expense  to 
the  United  States  in  returning  these  1,143  deports  was  relatively 
negligible,  as  this  was  largely  borne  by  the  steamship  companies, 
while  New  York  State  bore  the  entire  cost  of  sending  home  970 
repatriates  and  614  nonresidents,  the  remaining  707  repatriates 
and  797  nonresidents  going  at  their  own  expense  or  that  of  their 
relatives  or  friends. 

The  great  increase  in  recent  years  in  the  numbers  of  the  in- 
sane sent  to  their  homes  from  this  State  is  shown  by  the  tables 
on  page  10. 

In  repatriation  the  State  first  ascertains  the  willingness  of  the 
alien  to  return,  next,  if  possible,  whether  his  friends  in  the  country 
from  which  he  emigrated  will  provide  for  him  when  he  is  returned ; 
further,  that  he  is  in  a  fit  condition  to  travel;  and  beyond  all 
this,  it  is  the  custom  to  buy  his  ticket  to  his  own  home,  and,  when 
necessary,  to  send  with  him  a  nurse  or  attendant  whose  expenses 
are  paid  by  the  State  of  New  York.  Moreover  the  alien  is  pro- 
vided with  a  sum  of  money  to  place  in  his  pocket  on  his  return 
home. 

The  remarkable  thing  about  repatriation  is  that  it  is  con- 
ducted under  no  asserted  right  whatsoever  of  the  State  of  New 


REPORT  OF  SPECIAL  COMMISSIONER  61 

York,  but  only  by  and  with  the  consent  of  the  repatriates  them- 
selves, their  relatives  or  friends  and  under  an  informal  arrange- 
ment with  the  various  steamship  lines  entering  the  port  of  !N"ew 
York. 

The  number  of  the  alien  and  nonresident  insane  in  our  State 
hospitals  who  can  be  repatriated  or  returned  is  determined  pri- 
marily by  the  amount  of  the  appropriations  made  each  year  for 
that  purpose  by  the  State  Legislature. 

In  some  years  the  legislative  appropriations  have  been  insuf- 
ficient to  enable  the  State  authorities  to  repatriate  or  return  all 
of  the  alien  or  non-resident  insane  who  were  willing  to  go  back 
to  their  homes.  For  example  the  Board  of  Alienists  stated  in 
their  annual  report  for  1911  that  at  the  close  of  the  fiscal  year 
nearly  300  alien  patients  remained  in  the  State  hospitals  solely 
because  of  lack  of  funds  to  secure  their  repatriation. 

Moreover  the  insane  aliens,  their  friends  and  relatives  ap- 
parently are  becoming  more  eager  to  take  advantage  of  repatria- 
tion through  the  Bureau  of  Deportation,  both  because  of  the  safe 
and  humane  method  of  return  which  it  affords  and  also  because 
in  many,  if  not  in  the  majority  of  cases,  the  alien  is  benefited 
both  physically  and  mentally. 

In  comparison  with  the  resultant  saving  to  the  State  as  hereto- 
fore shown  herein,  the  total  amount  of  the  appropriations  for 
the  Board  of  Alienists  and  its  successor,  the  Bureau  of  Deporta- 
tion, from  the  beginning  of  the  work  in  1905  to  and  including 
1913  are  insignificant. 

Aside  from  all  eugenic  considerations  and  looking  at  the 
matter  simply  from  the  financial  standpoint  the  State  of  !N"ew 
York  can  appropriate  funds  for  no  purpose  so  profitable  as  that 
of  removing  from  its  borders  the  alien  and  nonresident  insane 
who  desire  to  return  to  their  homes. 

As  it  appears  that  of  the  alien  first  admissions  to  the  New  York 
hospitals  during  the  years  1905  to  1912  inclusive,  more  than  SO  ' 
per  cent  were  admitted  after  the  time  had  expired  within:  which 
they  could  be  deported  under  the  Immigration  Act,  the  only 
way  of  removing  these  aliens  from  our  hospitals  under  existing 
conditions  is  by  repatriation  through  the  State  Bureau  of  De- 
portation. This  gives  some  idea  of  the  importance  of  the  work 


62     ALIEN  INSANE  IN  CIVIL  HOSPITALS  OF  NEW  YORK  STATE 

of  this  Bureau,  the  necessity  of  furnishing  it  with  adequate 
appropriations  and  the  saving  it  can  accomplish  for  the  State, 
having  in  mind  the  fact  that  on  September  30,  1912,  there  were 
9,241  aliens  in  our  hospitals. 

Through  the  work  of  the  Bureau  of  Deportation  in  1912  the 
net  increase  of  patients  receiving  care  at  the  expense  of  the  State 
was  the  smallest  in  many  years.  This  result  gives  hope  that  the 
abnormal  rate  of  increase  of  past  years  may  be  obliterated. 

It  is  the  opinion  of  this  Commission,  as  the  result  of  its  in- 
vestigation, that  with  an  efficient  and  sufficient  personnel  and 
with  adequate  funds  at  its  disposal  the  Bureau  of  Deportation 
can  remove  this  year  from  the  various  institutions  of  this  State 
many  more  alien  and  nonresident  insane  than  have  been  removed 
therefrom  in  any  single  year  since  the  work  was  organized  in 
1905. 

DIFFICULTIES   WITH    STEAMSHIP    COMPANIES   IN    REPATRIATING 

INSANE  ALIENS 

In  the  past  the  State  authorities  have  encountered  much  oppo- 
sition from  transatlantic  steamship  companies  entering  the  Port 
of  New  York  to  receiving  as  passengers  insane  aliens  able  to 
travel.  The  annual  reports  of  the  Bureau  of  Deportation  for 
1912  and  of  the  Board  of  Alienists  for  1911,  show  that  many 
such  cases  were  refused  passage. 

Under  date  of  November  17,  1912,  various  transatlantic  lines 
entered  into  an  arrangement  with  the  New  York  State  officials 
which  provided  uniform  rules  for  sending  insane  aliens  abroad,  the 
substance  of  which  is  as  follows : 

"  1.  The  New  York  State  Hospital  Commission  have  ad- 
vised that  they  will  not  ask  for  tickets  for  any  patients  who 
are  not  in  condition  to  travel  without  danger  to  themselves 
or  others,  or  for  any  patient  who  would  give  trouble  to  the 
officials  of  the  ship  or  other  passengers. 

"2.  In  the  event  of  the  Commission  sending  patients  who 
would  be  liable  to  need  special  care  and  attention  a  compet- 
ent attendant  will  accompany  them. 

"  3.  The  right  of  the  alien  to  return  must  be  fully  estab- 
lished to  the  satisfaction  of  the  line. 


Kl-:i>OKT    OK    Sl'KCJAL    COMMISSIONER  (\-> 

"  4.  The  State  Hospital  Commission  to  furnish  certificate 
stating  the  exact  condition  of  the  alien,  and  giving  full 
particulars  as  far  as  known  of  the  case. 

"  5.  The  State  Hospital  Commission  to  furnish  transport- 
ing line  with  the  name  and  address  of  the  nearest  relatives 
abroad  who  will  care  for  the  passenger  after  arrival. 

"  6.  The  State  Hospital  Commission  to  purchase  tickets 
for  such  passengers  only  through  the  head  offices  of  the  lines 
in  New  York. 

"  7.  That  as  far  as  possible  insane  aliens  will  be  returned 
to  the  country  from  whence  they  came  on  the  lines  which 
brought  them." 

The  foregoing  arrangement  is  entirely  informal,  is  not  legally 
binding,  and  no  definite  duration  being  stated,  may  be  terminated 
at  any  time  and  without  notice  by  the  steamship  companies. 

It  seems  superfluous  to  point  out  that  the  right  of  the  State  of 
New  York  to  repatriate  aliens  by  the  steamship  companies 
which  originally  brought  the  aliens  to  this  country  should  be 
derived  from  the  law  and  not  rest  upon  an  unstable  understanding. 

Under  section  21  of  the  Immigration  Act  steamship  companies 
are  guilty  of  a  misdemeanor  and  subject  to  a  fine  of  not  less  than 
$300,  the  vessel  being  denied  clearance  until  the  fine  is  paid,  "  for 
failure  or  refusal  *  *  *  to  take  on  board,  guard  safely  and 
return  to  the  country  whence  he  came  any  alien  ordered  to  be 
deported." 

Steamship  companies  should  be  under  the  same  legal  penalties 
"  for  failure  or  refusal  to  take  on  board,  guard  safely  and  return  " 
those  whom  the  State  desires  to  repatriate  as  those  whom  the 
United  States  orders  deported.  The  Immigration  Act  should  be 
amended  to  this  effect  and  the  State  of  New  York  should  enact  a 
law  to  accomplish  the  same  purpose. 

EXAMINATION  OF  IMMIGRANTS  BY  THE  STEAMSHIP  COMPANIES 
The  testimony   of  representatives   of  various   steamship  com- 
panies entering  the  Port  of  New  York  developed  a  further  reason 
for  the  heavv  burden  of  foreign-born  insane  that  the  State  of 


<34     ALIEN  INSANE  IN  CIVIL  HOSPITALS  OF  NEW  YORK  STATE 

.Xew  York  is  obliged  to  bear,  which  is  much  more  than  that  of 
any  other  State  in  this  country. 

\7arious  methods  of  medical  examination  of  immigrants  are 
employed  by  the  different  steamship  companies.  On  the  borders 
of  Germany  certain  steamship  lines  jointly  maintain  the  so-called 
"  Control  Stations  "  at  which  all  immigrants  from  Russia  must 
be  examined  before  they  are  permitted  to  pass  through  Germany. 
At  these  stations  the  doctor  of  the  steamship  companies  examines 
the  immigrants  to  ascertain  if  they  come  within  the  requirements 
of  the  Federal  Immigration  Act.  On  the  way  to  Hamburg  the 
Russians  are  submitted  to  a  cursory  examination  at  a  suburb  of 
Berlin  by  another  physician  of  the  steamship  lines,  are  looked  over 
by  other  doctors  of  the  companies  in  the  immigrant  halls  at  Ham- 
burg, more  particularly  with  reference  to  contagious  diseases  and 
hernia,  and  finally  file  before  a  government  doctor  and  a  ship's 
doctor  as  they  embark  upon  the  transfer  boat. 

Of  the  remaining  immigrants  from  Northern  Europe  some  are 
subjected  only  to  the  examination  of  passing  in  line  before  ex- 
amining physicians  as  they  embark,  while  others  in  addition  to 
this  undergo  an  examination  like  that  had  in  the  immigrant 
halls  at  Hamburg. 

In  Great  Britain  there  is  but  one  examination  made  of  British 
immigrants,  which  is  conducted  upon  the  wharf  of  the  steamship 
company  or  upon  the  lighter  which  carries  the  immigrants  to  the 
ship. 

In  Italy  the  examination  is  made  at  the  various  ports  by  an 
official  of  the  Italian  Government,  assisted  by  the  ship's  surgeon 
and  in  some  instances  (through  the  courtesy  of  the  Italian  Govern- 
ment) by  an  officer  of  the  United  States  Public  Health  Service. 
The  chief  purpose  however  of  the  presence  of  the  latter  at  the 
examination  is  the  detection  of  trachoma  —  a  contagious  disease 
of  the  eyes. 

The  value  of  these  examinations  in  detecting  mental  defects  or 
psychoses  may  be  readily  seen  when  we  are  told,  for  example,  that 
the  British  immigrants  are  examined  during  the  time  required 
for  the  barge  to  go  from  the  landing-place  to  the  ship,  which 


KEPOKT  OF  SPECIAL  COMMISSIONER  05 

means  that  from  200  to  600  are  examined  in  about  half  an  hour, 
or  from  7  to  20  per  minute,  and  that  at  the  Italian  ports  the 
lowest  rate  of  examination  is  200  per  hour,  and  the  highest  rate 
400  per  hour,  or  about  3  to  6  per  minute.  We  are  further  told 
that  these  immigrants  are  under  observation  during  their  journey 
from  the  port  of  embarkation  to  Ellis  Island,  but  that  no  special 
examination  is  made  as  to  their  mental  condition. 

No  testimony  was  produced  before  this  Commission  which 
showed  anything  approaching  an  adequate  examination  by  the 
steamship  companies  for  the  detection  of  mental  diseases.  Such 
examinations  as  were  had  appeared  to  be  merely  incidental  to  the 
examination  to  detect  the  physical  diseases  which  exclude  immi- 
grants under  the  Federal  Immigration  Act, 

Section  9  of  the  Immigration  Act  imposes  a  fine  of  $100  upon 
a  transportation  company  (other  than  railway  lines  entering  the 
United  States  from  foreign  contiguous  territory)  bringing  into 
this  country  "  any  alien,  subject  to  any  of  the  following  disabili- 
ties: idiots,  imbeciles,  epileptics  or  persons  afflicted  with  tuber- 
culosis or  with  a  loathsome  or  dangerous  contagious  disease  "  if  it 
appears  to  the  satisfaction  of  the  'Secretary  of  Labor  that  the  alien 
was  so  diseased  or  disabled  at  the  time  of  foreign  embarkation  and 
that  the  existence  of  such  disease  or  disability  might  have  been 
detected  by  means  of  a  competent  medical  examination  at  such 
time. 

The  mental  defectives  and  the  insane  excluded  from  admission 
into  the  United  States  under  section  2  of  the  Immigration  Act,  as 
heretofore  stated,  include  "All  idiots,  imbeciles,  feeble-minded 
persons,  epileptics,  insane  persons,  and  persons  who  have  been  in- 
sane within  five  years  previous ;  persons  who  have  had  two  or 
more  attacks  of  insanity  at  any  time  previously;  "  *;  persons 
likely  to  become  a  public  charge ;  *  *  ;  persons  not  compre- 

hended within  any  of  the  foregoing  excluded  classes  who  are  found 
to  be  and  are  certified  by  the  examining  surgeon  as  being  mentally 
or  physically  defective,  such  mental  or  physical  defect  being  of  a 
nature  which  may  affect  the  ability  of  such  alien  to  earn  a  living." 

Though  the  insane  and  feeble-minded  are  forbidden  entry  into 
this  country  by  section  2  of  the  Immigration  Act  there  is  no 

3 


66     ALIEN  INSANE  IN  CIVIL  HOSPITALS  OF  XEW  YORK  STATE 

penalty  imposed  by  section  9  thereof  for  bringing  them  here,  the 
importation  of  "  idiots,  imbeciles  and  epileptics  "  alone  in  the 
aforementioned  excluded  classes,  being  a  Unable  offense. 

This  condition  should  be  remedied  and  section  9  of  the  Immi- 
gration Act  should  be  broadened  so  as  to  include,  in  the  same 
manner  as  in  the  proposed  amendment  to  section  2,  not  only  the 
insane  and  the  mental  defectives,  but  also  persons  with  chronic 
alcoholism  and  persons  with  constitutional  psychopathic  in- 
feriority, while  the  amount  of  the  fine  should  be  substantially  in- 
creased. 

With  their  agencies  all  over  Europe  the  steamship  companies 
have  both  facilities  and  opportunity  for  making  careful  investiga- 
tion and  examination  of  intending  immigrants  in  order  to  prevent 
the  classes  above  enumerated  from  coming  to  us  and,  in  view  of  the 
profits  derived  by  these  companies  from  immigrant  traffic,  it  is 
but  reasonable  that  they  should  be  required  to  do  this,  to  the  best 
of  their  ability. 

To  see  what  may  be  accomplished  along  similar  lines  we  need 
only  consider  what  has  been  done  in  the  past  toward  eliminating 
from  among  immigrants  some  of  the  contagious  diseases. 

INADEQUACY    OF    MEANS    FOR   DETECTING    INSANITY    OF    IMMI- 
GRANTS AT  THE  PORTS  OF  DEBARKATION 

As  to  the  examinations  heretofore  had  at  Ellis  Island,  it  is  sufhV 
cient  to  quote  from  an  address  of  the  Hon.  William  Williams, 
late  United  States  Commissioner  of  Immigration,  before  the 
Mental  Hygiene  Conference  at  New  York  City,  November  14, 
1912,  in  which  he  says: 

"  I  shall  refer  only  to  the  detection  of  the  mental  diseases 
with  which  immigrants  may  be  afflicted,  and  shall  show  how 
inadequate  are  the  ways  and  means  which  Congress  has  pro- 
vided therefor.  I  am  one  of  those  who  believe  that  the  Legis- 
lature does  only  half  its  duty  when  it  enacts  a  good  law.  The 
other  half  is  to  furnish  adequate  machinery  and  ways  and 
means  for  its  execution,  without  which  the  law  accomplishes 
only  a  part  of  its  purpose,  and  is  there  to  perplex  executive 
officials  whose  sworn  duty  and  desire  it  is  to  execute  it. 


REPORT  OF  SPECIAL  COMMISSIONER  07 

"  Immigration  to  this  county  is  at  a  very  heavy  rate.     In 
round  numbers   it  has  during  each   of  the  past  ten  years 
averaged  900,000  annually,  and  the  great  bulk  of  it  has  been 
through  Ellis  Island.     Only  last  month  there  arrived  at  New 
York  over  80,000  aliens,  an  average  of  nearly  2,600  a  day. 
Nor  are  the  arrivals  evenly  distributed  over  the  days  of  the 
month,  on  the  contrary  there  arrive  sometimes  for  several 
days  in  succession  4,000  or  5,000  a  day.     A  great  many  of 
these  people  come  from  the  poorer  classes  of  the  poorer  coun- 
tries of  Europe.     Their  general  physical  condition  is  often 
far  from  good  and  their  ignorance  beyond  belief.     Not  only 
are  many  illiterate,  but  many  do  not  know  the  days  of  the 
week,  the  months  of  the  year,  their  ages,  or  any  country  in 
Europe  outside  of  their   own.      These  people   speak  many 
strange  tongues  and  dialects,  and  interpreters  familiar  with 
approximately  forty  are  necessary  to  enable  the  government 
authorities  to  converse  with  them.     A  number  of  those  who 
are  undesirable  additions  to  our  population  are  nevertheless 
admissible  under  the  low  requirements  of  existing  law.     Ob- 
viously the  task  of  picking  out  from  amongst  this  heterogen- 
eous mass  those  suffering  from  any  mental  disability  is  a 
gigantic  one.     It  would  be  impossible  of  complete  perform- 
ance even  if  the  medical  staff  was  in  size  what  it  should  be. 
But  Ellis  Island  has  to  transact  its  heavy  business  with  the 
instrumentalities  and  facilities  which  Congress  provides.     It 
has  in  all  650  officials.     Of  these  about  130  belong  to  the 
Public  Health  Service,  which  number  includes  all  medical 
officers, (doctors),  hospital  attendants,  and  nurses.     The  medi- 
cal officers  number  only  21,  far  too  few,  for  they  have  to  per- 
form a  multitude  of  duties  in  relation  both  to  the  inspection 
of  the  masses  of  immigrants  who  arrive  and  the  care  of  those 
detained  at  Ellis  Island  hospitals  for  sickness,  such  sick  num- 
bering at  times  several  hundred. 

"  The  process  of  medical  inspection  is  roughly  this :  Each 
immigrant  passes  before  two  medical  officers  who  rapidly 
look  him  over  with  a  trained  eye  and  set  aside  for  special 
examination  all  who  bear  any  indications  of  physical  or 


CS     ALIEN  INSANE  IN  CIVIL  HOSPITALS  OF  NEW  YORK  STATE 

mental  defects.  Those  so  set  aside  are,  for  the  purposes  of 
mental  examination,  subjected  to  well  systematized  test  ques- 
tions, which  the  medical  officers  have  evolved  from  their  own 
special  experience,  and  they  apply  also  such  recent  modern 
and  scientific  methods  as  those  worked  out  by  Biiiet-Simon, 
Fernald,  Goddard,  and  others.  All  such  special  cases,  of 
which  last  year  there  were  about  5,000,  are  gone  into  very 
thoroughly  and  are  often  detained  eight  days,  or  longer,  for 
mental  observation.  But  not  enough  cases  are  thus  set 
aside,  because  the  medical  officers  are  compelled  to  work  too 
quickly  and  lack  the  requisite  number  of  interpreters  to 
enable  them  to  converse  with  each  immigrant  as  he  goes 
by.  Furthermore,  the  space  at  Ellis  Island  available  for  the 
observation  of  immigrants  suspected  to  be  suffering  from 
mental  defects  is  too  small." 

Mr.  Williams  further  stated  that  he  had  frequently  called 
attention  to  these  matters,  asking  for  an  additional  force  of 
medical  officers,  for  better  accommodations  for  the  examination  of 
the  incoming  immigrants,  and  for  various  other  necessary 
facilities,  and  that  Congress  had,  to  a  limited  extent  only,  taken 
note  of  these  matters. 

Since  this  address  was  delivered  in  November,  1912,  reports 
from  Ellis  Island  show  that  the  examinations  there  made  for 
the  detection  of  mental  disease  have  been  much  more  effective 
than  formerly  but  that  the  number  of  medical  officers,  and  the 
facilities  and  funds  are  still  very  inadequate. 

NEW  ENVIRONMENT   OF  THE    IMMIGRANT 

It  has  been  suggested,  and  with  reason,  that  one  of  the  causes 
of  insanity  among  our  alien  population  is  changed  environment. 
Immigrants  are  plunged  into  a  hurried  struggle  for  existence, 
quite  different  in  many  instances  from  the  slower  and  more  even 
life  to  which  they  have  been  accustomed ;  a  vast  rural  population 
suddenly  enters  city  life;  they  are  in  a  strange  country,  whoso 
language,  food  and  customs  differ  from  their  own ;  they  are  called 
upon  to  make  unusual  exertions  and  to  undergo  much  privation, 


REPORT  OF  SPECIAL  COMMISSIONER  69 

frequently  in  order  that  they  may  send  for  their  families  as  soon 
as  possible,  and  often,  having  but  weak  resisting  powers,  they 
succumb  to  an  hereditary  taint  or  to  a  fundamental  defect  in 
personality  and  their  insanity  develops. 

It  is  doubtless  true  that  the  new  environment  of  the  immigrant 
is  in  part  responsible  for  some  of  the  insanity  among  aliens,  nut 
to  what  extent  it  is  impossible  at  this  time  to  determine.  It  is 
very  significant,  however,  that  many,  if  not  the  majority  of 
authorities  believe  that  an  unfavorable  environment,  as  a  cause 
of  insanity,  is  usually  associated  with  an  inherited  weakness  or  a 
fundamental  defect  in  makeup ;  that  the  mental  breakdown  occurs 
in  such  instances  when  the  stress  of  existence  bears  down,  upon 
an  individual  already  thus  predisposed, 

As  bearing  upon  the  subject  of  environment  some  of  the  statis- 
tics published  in  the  New  York  State  Hospital  Commission's 
"  Statistics  of  the  Insane  for  the  year  ending  September  30, 
1912  "  are  of  interest.  It  appears  therefrom  (pages  26  and  27) 
that  65.1  per  cent  of  all  the  first  admissions  to  the  civil  state  hospi- 
tals for  that  year  were  residents  of  first  class  cities,  New  York 
City  alone  furnishing  58.3  per  cent,  of  which  1,673  were  males 
and  1,672  females.  In  the  villages  and  rural  districts  the  male 
first  admissions  numbered  577  and  the  females  480,  while  in  the 
rural  districts  alone  the  male  first  admissions  numbered  205  and 
the  female  122. 

Of  the  first  admissions  for  1912  the  number  of  insane  per  100,- 
000  of  population  was  as  follows : 

Number  per  100,000 
of  population 

Whole  State   59.9 

First  class  cities 64 . 5 

Second  class  cities 54.1 

Third  class  cities   (20,000  to  50,000) 55.6 

Third  class  cities   (10,000  to  20,000) 63.5 

Third  class  cities   (   8,000  to  10,000) 49 . 9 

Villages  and  rural  districts 45  .  3 

The  greater  frequency  of  insanity  in  the  cities  as  compared  with 
the  country  is  apparent  from  the  foregoing. 


70     ALIEN  INSANE  IN  CIVIL  HOSPITALS  OF  NEW  YORK  STATE 

Other  interesting  data  in  "  Statistics  of  the  Insane"  show  that 
senile  insanity  is  relatively  less  frequent  in  the  larger  cities  than 
in  the  villages  and  rural  districts,  but  that  dementia  paralytica 
and  alcoholic  insanity  are  much  more  prevalent  in  the  former. 

To  improve  the  environment  of  the  immigrant  in  this  country 
is  highly  desirable,  but  that  alone  will  not  solve  this  portion  of  the 
problem  of  the  alien  insane,  if  we  are  to  continue  to  receive  nu- 
merous individuals  with  an  inherited  weakness  or  a  fundamental 
defect  in  makeup.  Both  improvement  in  environment  and  ex- 
clusion of  these  individuals  are  essential.  From  the  standpoint  of 
humanity  alone,  and  aside  from  all  thought  of  the  State,  the  com- 
munity and  the  future  generations,  we  should  not  permit  such 
persons  to  be  subjected  to  the  possibilities  of  mental  disaster  present 
in  a  new  and  strenuous  environment. 

PREVALENT  PSYCHOSES 

What  we  term  "  insanity  "  includes  many  different  mental  dis- 
eases or  "  psychoses."  In  a  study  directed  to  the  consideration  of 
insanity  as  a  disease  it  would  be  desirable  to  consider  these  psy- 
choses at  length. 

According  to  the  testimony  of  the  various  hospital  superinten- 
dents and  the  statistics  of  the  New  York  State  Hospital  'Com- 
mission the  most  prevalent  psychosis  in  the  civil  hospitals  of 
Xew  York  is  what  is  now  generally  known  as  dementia  praecox ; 
the  second  in  order  of  prevalence  is  general  paresis  (dementia 
paralytica)  with  manic-depressive  insanity,  senile  dementia  and 
alcoholic  insanity  following. 

The  first  of  these  is  an  incurable  psychosis  of  long  duration 
having  in  some  instances,  periods  of  lucidity ;  the  second  is  uni- 
formly fatal,  while  alcoholic  insanity  may  present  an  apparent 
cure  yet  the  individual  afflicted  with  it  usually  succumbs  to  his 
dispsomania  with  the  result  that  the  return  of  his  psychosis  is  only 
a  matter  of  time. 

From  the  testimony  of  the  hospital  superintendents  but  little 
difference  exists  in  the  prevalence  of  dementia  praecox  in  native- 
born  and  foreign-born,  but  general  paresis  and  alcoholic  insanity 
are  relatively  more  frequent  among  the  forei<rn-born  than  among 
the  native-born. 


REPORT  OF  SPECIAL  COMMISSIONER  71 

The  consensus  of  medical  opinion  given  this  Commission  was  to 
the  effect  that  dementia  praecox  and  manic-depressive  insanity 
depend,  in  a  great  number  of  instances,  upon  fundamental  de- 
fects, or  inherited  weaknesses,  while  the  causation  of  general 
paresis  was,  in  every  instance,  'ascribed  to  syphilis,  the  disease 
originating  five  years  or  more  after  the  appearance  of  the  original 
lesion. 

The  possibility  that  the  insane  may  procreate  does  not  in  all 
instances  terminate  upon  their  commitment  to  a  'State  hospital. 
In  cases  of  dementia  praecox  as  well  as  those  of  alcoholic  in- 
sanity, patients  not  infrequently  have  intervals  of  considerable 
duration  of  freedom  from  mental  symptoms,  during  which  they 
are  discharged  from  the  hospital  and  in  some  instances  have 
offspring  to  whom  the  hereditary  taint  may  be  transmitted. 

As  general  paresis  rarely  develops  within  five  years  after  the 
original  lesion,  and  often  not  until  ten  years  thereafter,  the  in- 
adequacy of  the  deportation  period  of  the  Federal  law  to  cover 
these  cases  is  obvious. 


X.    EUGENIC  EFFECTS 

However  urgent  the  economic  factors  in  the  problem  of  the 
alien  insane  may  be,  far  more  serious  possibilities  lie  in  the  effect 
of  the  mental  defectives  and  the  insane  within  our  borders  upon 
our  future  generations. 

Eugenics  —  the  practical  application  of  facts  learned  in  the 
study  of  heredity  —  is  one  of  the  most  recent  undertakings  for 
race  betterment,  dating  back  little  more  than  twelve  years,  while 
that  branch  of  it  relating  to  heredity  in  mental  defects  and  dis- 
eases was  taken  up  scarcely  more  than  five  years  ago,  research 
work  therein  being  confined  substantially  to  this  country  and 
Germany. 

From  the  results  already  obtained  we  can  see  how  important  to 
our  descendants  is  a  complete  knowledge  of  the  transmission  of  in- 
sanity and  mental  defect  by  heredity.  For  many  years  the  popu- 


7*2     ALIEN  INSANE  IN  CIVIL  HOSPITALS  OF  NEW  YORK  STATE 

lar  mind  has  associated  insanity  with  heredity.  This  belief  has 
been  confirmed  by  modern  investigation  so  far,  at  least,  as  to  assure 
us  that  heredity  is  by  far  the  most  important  single  factor  in  the 
causation  of  certain  forms  of  mental  diseases. 

To  ancestors  afflicted  with  feeble-mindedness,  with  dementia 
praecox  and  other  mental  disorders,  numerous  mentally  defective 
or  mentally  diseased  descendants  have  been  traced  in  many  of  the 
families  that  have  been  investigated,  while  in  a  few  of  the  cases 
examined,  where  one  party  to  the  marriage  was  normal  (and  pre- 
sumably of  pure  normal  ancestry)  the  other  being  insane,  some 
normal  children  resulted. 

The  result  of  investigations  of  heredity  in  mental  diseases  and 
defects  down  to  the  present  time  entirely  justifies  the  statement 
that  it  is  highly  undesirable  that  the  feebleminded,  epileptics  and 
those  with  certain  types  of  insanity  should  have  children. 

It  is  patent,  therefore,  that  both  the  insane,  the  mental  defec- 
tives, and  those  particularly  likely  to  become  insane,  who  are  so 
undesirable  as  parents  of  future  generations  of  Americans,  should 
be  excluded  so  far  as  possible  from  entry  into  this  State  and 
country.  If  however  they  have  been  admitted  and  have  not 
become  citizens  of  this  country  they  should  be  returned  to  the 
homes  from  which  tliev  came. 


XL    ATTITUDE  OF  OTHER  STATES 

At  the  suggestion  of  this  Commission,  the  Governors  of  the 
States  of  New  Hampshire,  Connecticut,  Massachusetts,  New 
Jersey,  Pennsylvania,  Maryland,  Rhode  Island,  Indiana,  Illinois, 
West  Virginia,  South  Carolina  and  Virginia,  have  been  making 
investigations  on  the  same  lines  as  those  conducted  in  this  State, 
and  several  of  them  have  undertaken  the  collection  of  data  on  his- 
tory cards  of  the  form  devised  by  this  Commission.  When  all  have 


REPORT  OF  SPECIAL  COMMISSIONER  73 

been  tabulated  we  will,  for  the  first  time,  have  data  concerning 
citizenship  and  based  upon  statistics  of  a  uniform  character. 

It  is  interesting  to  know  that  one  of  the  results  of  this  study  of 
their  own  problems  has  been  the  initiation  in  two  states  of  an 
organized  effort  to  deport  those  aliens  in  their  hospitals  for  the 
insane  who  were  clearly  deportable. 

It  would  seem,  however,  that  but  few  of  the  states  fully  realize 
the  importance  of  deportation  and  the  saving  resulting  therefrom, 
for  the  report  of  the  Bureau  of  Deportation  for  1913,  states  that, 
during  the  twelve  months  ending  September  30,  1913,  the  total 
number  of  insane  aliens  deported  from  all  ports  in  the  United 
States  upon  Federal  warrant  as  being  insane  from  causes  existing 
prior  to  landing  numbered  641;  that  of  those,  379  or  59.12  per 
cent  were  deported  from  New  York  State  through  the  certifica- 
tions of  that  Bureau,  leaving  262  or  41.88  per  cent  as  representing 
the  efforts  of  all  the  remaining  states. 

According  to  the  figures  of  the  census  of  1910  New  York  State 
had  16.7  per  cent  of  the  insane  in  institutions  in  the  United 
States,  while  in  1904,  the  last  year  of  which  figures  are  available, 
New  York  was  caring  for  25.2  per  cent  of  the  foreign-born  insane. 
No  similar  percentages  of  the  alien  insane  are  obtainable. 

While  the  burden  of  the  alien  insane  is  heaviest  in  the  State  of 
New  York  other  states  already  feel  it  to  a  greater  or  lesser  degree 
and  unless  speedy  action  be  taken  to  remedy  the  causes  of  present 
conditions  they  will  be  confronted  with  a  situation  similar  to  that 
existing  in  New  York.  As  no  single  state,  but  the  Federal  gov- 
ernment alone  has  power  in  the  premises,  to  obtain  the  necessary 
relief,  cooperation  is  much  to  be  desired. 


XII.    SUGGESTIONS  RECEIVED 

Various  methods  have  been  suggested  as  a  solution  to  this  vex- 
ing problem  among  them  the  following: 

(a)  That,  as  an  aid  to  existing  methods,  there  should  be  sta- 
tioned at  the  ports  of  embarkation  United  States  medical  officers, 
who  should  take  part  in  the  examination  of  the  intending  immi- 
grant. 


74     ALIEN  INSANE  IN  CIVIL  HOSPITALS  OF  NEW  YORK  STATE 

(b)  That  there  should  be  stationed  upon  each  ship  bearing 
immigrants  to  this  country  United  States  officials,  either  physi- 
cians or  nurses,   or  both,   who  should  observe  the  aliens  from 
time  to  time  and  report  to  the  immigration  officials  upon  arrival 
those  apparently  suffering  from  psychoses  or  mental  defects. 

(c)  That  a  larger  number  of  medical  officers  should  be  detailed 
to  Ellis  Island  and  other  large  ports,  and  that  these  physicians 
should  be  men  trained  in  the  detection  of  mental  diseases  and 
defects. 

(d)  That  there  be  provided  large  detention  hospitals  in  which 
suspected  cases  could  be  isolated  for  a  longer  or  shorter  period 
until  proper  investigation  could  be  made  as  to  their  mental  con- 
dition. 

(e)  That  the  time  during  which  deportation  can  be  effected 
under  Federal  warrant  be  lengthened  to  five  years,  or  longer. 

(f )  That  "  Decision  No.  120  "  should  be  rescinded  and  the  testi- 
mony of  compentent  alienists  as  to  mental  condition  be  taken 
as  sufficient  authority  for  the  issuance  of  Federal  warrants  of 
deportation,  if  other  conditions  admit. 

(g)  That  the  law,   instead  of  providing  that  the  authorities 
show   that  the   causes   of   the   alien's  psychosis  existed   prior  to 
his  landing,  should  provide  that  the  alien  should  show  that  the 
causes  of  his  psychosis  arose  subsequent  to  his  landing,  thus  put- 
ting the  burden  of  proof  upon  the  alien  rather  than  upon  the  State. 

(hj)  That  the  steamship  companies  which  bring  immigrants  to 
this  country  be  made  responsible  for  the  mental  condition  of  the 
immigrants,  as  well  as  for  the  physical  condition.  In  other  words, 
the  steamship  companies  shall  make  careful  investigation  into 
the  family  history  and  general  surroundings  of  the  proposed 
immigrants  at  their  homes  in  order  to  determine  that  there  is  no 
hereditary  taint. 


REPORT  OF  SPECIAL  COMMISSIONER  75 


RECOMMENDATIONS 

I.     FOE  THE  STATE  OF  NEW  YORK 

1.  EXCLUSION    OF    INSANE    AND   MENTALLY    DEFECTIVE    IMMI- 

GRANTS AT  THE  TIME  OF  THEIR  ARRIVAL 

(a)  The  present  law   (chapter  27  of  the  Consolidated  Laws, 
article  II,  section  19,  as  amended  by  chapter  121  of  the  Laws  of 
1912)  provides  that  the  Bureau  of  Deportation  "  shall  maintain 
a  careful  inspection  and  observation  of  the  methods  and  facilities 
for  examining  immigrants  for  mental  disease  and  defect  at  the 
Port  of  Xew  York,  and  shall,  from  time  to  time,  report  to  the  com- 
mission    upon     the    methods     employed,     and     their    efficiency 

4f        *        *  J? 

This  is  probably  as  much  as  can  be  done  by  the  State  in  regard 
to  the  examination  of  immigrants,  for  the  only  authority  under 
which  an  insane  alien  can  be  debarred  from  entering  this  country 
is  the  Federal  law  which  can  be  enforced  only  by  Federal  officials. 

(b)  The  State,  through  its  Executive  or  its  Legislature,  may 
urge  upon  Congress  the  necessity  of  providing  sufficient  appro- 
priations for  the  efficient  enforcement  of  the  Immigration  Act  and 
of  enacting  needed  amendments  thereto. 

2.  DEPORTATION     BY   FEDERAL   WARRANT     OF    INSANE   ALIENS 

WHO  BECOME  PUBLIC  CHARGES  FROM  PRIOR  CAUSES  OR 
ARE  FOUND  IN  THE  STATE  IN  VIOLATION  OF  THE  IMMIGRA- 
TION ACT 

(a)  The  part  of  the  State  in  effecting  deportation  of  insane 
and  mentally  defective  aliens  consists  in  reporting  such  cases  to 
the  United  States  immigration  authorities,  furnishing  information 
for  the  verification  of  their  landing,  and  certifying  to  the  condi- 
tions found  and  their  origin  from  causes  which  existed  prior  to 
landing. 

This  work,  so  far  as  it  relates  to  the  insane,  should  be  performed 
more  efficiently  each  year  by  the  Bureau  of  Deportation,  with  the 
cooperation  of  the  -State  Hospital  Commission  and  the  superin- 
tendents of  State  hospitals,  provided  that  adequate  funds  be  fur- 
nished therefor. 


7<»      ALIKX    INSANE  IN  CIVIL  HOSPITALS  OF  I^EW  YORK  STATE 

The  necessity  of  experienced  alienists  in  the  Bureau  of  Depor- 
tation is  clearly  apparent  when  it  is  recalled  that  in  order  to 
deport  an  insane  alien  under  Federal  warrant  it  must  be  proved, 
among  other  things,  that  the  alien's  insanity  arose  "  from  causes 
existing  prior  to  landing  "  in  this  country.  This  fact  in  most 
instances  can  he  established  only  by  expert  medical  opinion. 

(b)  Superintendents  of  State  hospitals  should  make  the  most 
diligent  efforts  to  determine,  at  the  time  of  admission,  the  citizen- 
ship of  every  patient;  should  immediately  notify  the  Bureau  of 
Deportation  not  only  of  all  admissions  known  to  be  aliens  but  of 
all  not  known  to  be  citizens.     For  this  purpose  and  to  obtain  the 
information  essential  for  the  verification  of  landing,  a  sufficient 
number  of  attendants  able  to  speak  foreign  languages  should  be 
employed,  and,  in  the  case  of  languages  less  frequently  spoken, 
the    temporary    services    of    interpreters    should    be     enlisted. 
Unfortunately  it  appears  that  the  number  of  attendants  speaking 
foreign  languages  and  of  interpreters  in  the  State  hospitals  is 
quite  inadequate.     Moreover,  it  has  been  shown  that  attendants 
speaking  the  language  of  the  alien  insane  patient  are  of  great 
assistance  in  the  diagnosis  of  the  patient's  affliction  and  in  the 
treatment  thereof. 

(c)  Physicians  of  the  Bureau  of  Deportation  should  make  fre- 
quent visits  to  all  th'j  State  hospitals  to  aid  in  making  the  needed 
investigations  of  aliens  and  to  see  that  no  deportable  aliens  have 
been  overlooked  by  the  hospital  authorities. 

(d)  Everything  possible  should  be  done  to  insure  the  fullest 
cooperation  between  the  Federal  and  State  authorities  in  these 
deportations. 

As  deportation  under  Federal  warrant  is  effected  with  but  little 
expense  to  the  State,  every  effort  should  be  made  to  utilize  the 
provisions  of  the  Immigration  Act  to  the  fullest  extent. 

(3)  REPATRIATION  OF  ALIENS  WITH  THEIR  CONSENT  AND  KE- 
TURN  OF  NONRESIDENTS  AT  EXPENSE  OF  STATE  OR  FRIENDS 
(a)  For  the  past  three  years  the  number  of  aliens  repatriated 
and  of  nonresidents  returned  from  this  State  has  each  exceeded 
the  number  of  aliens  deported  therefrom  by  the  Federal  authori- 
ties. 


REPORT  OF  SPECIAL  COMMISSIONER  77 

As  attendants  are  employed  more  frequently  by  the  State  than 
by  the  Federal  authorities  the  methods  of  repatriation  are  more 
humane  and  efficient  than  those  of  deportation.  Repatriation 
is,  however,  the  more  difficult  and  expensive  method.  Success  is 
largely  dependent  upon  the  appropriations  available.  If  the 
Bureau  of  Deportation  is  not  equipped  with  a  staff  adequate  in 
numbers  and  ability  and  supplied  with  a  sufficient  appropriation 
the  work  will  suffer,  from  which  large  financial  loss  to  the  State 
must  result. 

(b)  As  repatriation  depends  at  present  upon  the  consent  of  the 
steamship  companies  it  is  highly  desirable  that  the  rights  of  New 
York  State  in  this  matter  should  be  protected  without  further 
delay  by  amendments  to  the  Federal  and  State  laws. 

(c)  Communication   with   the   proper    authorities   of   foreign 
governments  should  be  established  through  and  with  the  coopera- 
tion of  the  Federal  government  in  order  that  better  arrangements 
than  those  now  existing  may  be  made  for  the  reception  and  care 
of  insane  aliens  repatriated  by  the  State  and  for  improving  the 
status  of  attendants  accompanying  them. 

(d)  Existing    facilities    for    statistical    research    should    be 
extended  and  used  to  the  fullest  extent  for  the  study  of  the  whole 
question  of  the  alien  insane,  along  the  lines  of  this  inquiry,  as  it 
would  be  a  serious  mistake  to  fail  to  continue  statistical  studies 
similar  to  those  herein  presented.     As  long  as  immigration  con- 
tinues, the  problem  of  the  alien  insane  will  be  present  and  to  reach 
an  accurate  solution  of  it  without  full  and  recent  statistical  infor- 
mation will  be  impossible.     The  value  of  the  material  gathered  is 
enhanced  by  the  fact  that  already  other  states  are  preparing  sta- 
tistics along  the  lines  followed  by  this  Commission,  from  which 
valuable  comparative  studies  should  be  made. 


78     ALIEN  INSANE  IN  CIVIL  HOSPITALS  OF  NEW  YORK  STATE 


II.  FOR  ACTION  BY  THE  UNITED  STATES  GOVERNMENT 

A.     UNDER  EXISTING  LAWS 

1.  EXCLUSION  OF  INSANE  AND  MENTALLY  DEFECTIVE  IMMIGRANTS 
AT  THE  TIME  OF  THEIR  ARRIVAL 

(a)  The  mental  and  physical  examination  of  immigrants  is  the 
responsibility  of  the  United  States  Public  Health  Sendee.     There 
is  need  for  the  employment  at  the  ports  of  entry  of  more  trained 
alienists.      These  officers  have  to  devote  much  of  their  time  to 
examinations  for  physical  diseases  and  defects. .    That  the  force 
of  alienists  has  been  insufficient  is  shown  by  the  increase  in  the 
number  rejected  on  the  mental  examination  whenever  in  the  past 
additional  alienists  have  been  assigned  to  duty  at  Ellis  Island. 

(b)  As  far  as  possible,  physicians  skilled  in  the  detection  of 
mental  diseases  and  defects  should  be  selected  from  the  candidates 
for  admission  to  the  United  States  Public  Health  Service. 

(c)  Physicians  in  this  Service  should  be  detailed  for  training 
at  hospitals  for  the  insane  in  order  to  insure  a  greater  number 
of  alienists.     This  was  done  at  one  time  but  was  discontinued 
some  six  years  ago. 

(d)  The  three  foregoing   recommendations  can  be  put   into 
effect  without  legislation  except  the  necessary  appropriations  for 
pay   and   allowance  for  the  additional   officers   needed.      Unless 
these  things  are  done  much  of  the  legislation  recommended  for 
the  detection  of  the  insane  and  the  mental  defectives  at  the  ports 
of  entry  will  be  ineffective. 

(e)  Employment  and  careful  training  of  a  sufficient  number 
of  interpreters  for  this  part  of  the  medical  examination  is  needed. 
A  difference  of  opinion  as  to  which  department  of  the  Federal 
government  should  employ  such  interpreters  has  prevented  their 
appointment.     This  is  a  trivial  matter  compared  with  the  great 
importance  to  the  states  which  bear  the  burden  of  the  alien  insane 
of  providing  such  urgently  needed  assistance. 

2.  DEPORTATION     BY    FEDERAL   WARRANT     OF    INSANE   ALIENS 

Wno  BECOME  PUBLIC  CHARGES  FROM  PRIOR  CAUSES  OR  ARE 

FOUND  IN  THE  STATE  IN  VIOLATION  OF  LAW 

(a)   A  more  active  policy  on  the  part  of  the  Federal  authorities 

in  enforcing  this  part  of  the  law  is  needed.     They  should  cooper- 


REPORT  OF  SPECIAL  COMMISSIONER  79 

ate  to  the  fullest  extent  with  the  State  authorities  to  render  the 
law  as  effective  as  possible.  At  present  practically  the  whole  bur- 
den of  proving  an  aliens'  deportability  and  even  his  identity  is 
thrust  upon  the  State  authorities.  Xo  aid  is  rendered  by  the 
Government  in  securing  information  necessary  to  verify  the  land- 
ing. When  it  is  remembered  that  many  deportable  aliens  are  pub- 
lic charges  through  the  inability  or  the  failure  of  the  Federal 
Government  to  determine  their  condition  upon  arrival,  sudu  ;<ti- 
tude  is  inconsistent.  Moreover  it  indicates  indifference  to  the 
rights  of  the  several  states  and  to  the  unnecessary  burdens  placed 
upon  their  taxpayers. 

(b)  The  period  for  which  the  Government  should  reimburse  the 
State  for  the  cost  of  the  maintenance  of  deportable  alien  patients 
should  be  fixed  so  as  to  begin  with  the  admission  of  the  alien  to 
a  hospital  for  the  insane.     This  can  be  done  without  change  in 
the  Immigration  Act  as  the  present  rule  was  made  by  the  former 
Department  of  Commerce  and  Labor.  .Until  April  1,  1911,  this 
cost  of  maintenance  was  paid  from  the  time  the  Department  of 
Commerce  and  Labor  was  notified  of  the  presence  of  the  alien  in 
a  hospital  for  the  insane  to  the  time  of  his  deportation.     As  has 
been  heretofore  stated  the  Deparment  of  Labor  on  January  1, 
191-1,  discontinued  even  the  meagre  payments  theretofore  made 
~New  York  State  for  the  care  and  maintenance  of  deportable  aliens, 
pursuant  to  Subd.  7,  Rule  22,  Immigration  Rules,  because  of  in- 
sufficient appropriations.     The  proper  method  of  dealing  with  this 
matter  would  be  to  amend  the  Immigration  Act  so  as  to  make  pay- 
ments for  the  deportable  insane  mandatory,  as  hereinafter  recom- 
mended. 

(c)  Warrants  of  deportation  should  not  be  cancelled  without 
giving  the  State  opportunity  to  present,  after  due  notice,  all  its 
evidence.    In  the  past  warrants  have  been  cancelled  upon  evidence 
which,  in  several  instances,  the  -State  would  have  been  able  to 
refute  if  given  the  opportunity. 

(d)  "  Decision  !N~o.   120,"  hereinbefore  referred  to,  which  is 
a  departmental  ruling,  should  be  annulled. 

(e)  Trained  attendants  should  be  sent  with  deported  aliens  to 
their  final  destination  in  all  cases  in  which  it  is  certified  by  a 
medical  officer  of  the  United  States  Public  Health  Service,  or  by 


80     ALIEN  INSANE  IN  CIVIL  HOSPITALS  OF  NEW  YORK  STATE 

the  chief  medical  officer  of  the  institution  in  which  such  aliens  have 
been  under  treatment,  that  special  care  and  attendance  is  needed  by 
reason  of  the  mental  or  physical  condition  of  such  aliens.  The 
present  law  permits  this  to  be  done,  but  in  the  past  it  has  been  the 
practice  of  the  Government  to  require  the  steamship  companies  to 
furnish  such  special  care  and  attendance  and  to  accept  from  these 
companies  documentary  evidence,  of  a  very  unsatisfactory  nature 
in  some  instances,  of  the  delivery  of  the  alien  to  relatives  or  the 
proper  authorities  abroad.  As  a  result,  some  deported  patients 
have  suffered  from  neglect  or  ill-treatment. 

B.     NEW  LEGISLATION   RECOMMENDED 

1.  EXCLUSION  OF  INSANE  AND  MENTALLY  DEFECTIVE  IMMI- 
GRANTS AT  THE.  TIME  OF  THEIR  ARRIVAL  OR  BEFORE  EM- 
BARKATION 

(a)  The  Immigration   Act   should   exclude   immigrants   with 
chronic  alcoholism  and  those  with  constitutional  psychopathic  in- 
feriority.    Many  of  these  cases  though  detected  at  the  ports  of 
entry  pass  the  inspecting  officers  as  the  present  law  does  not 
forbid  their  admission.     At  best  they  can  never  become  useful 
or  desirable  citizens  and  too  frequently  they  become  patients  in 
our  State  hospitals.     Moreover,  as  heretofore  stated  (p.  52),  per- 
sons who  have  been  insane  at  any  time  previously  should  be  for- 
bidden entry  and  the  exclusion  of  all  mentally  defective  persons 
should  be  made  mandatory. 

(b)  The  Immigration  Act  should  provide  that  each  immigrant 
examined  receive  at  the  port  of  entry  from  the  medical  officer 
or  officers  who  examined  him   a   certificate  that  no  mental   ov 
physical  diseases  or  defects  were  found  or  that  those  found  had 
been  set  forth  therein.    Something  of  this  character  should  be  done 
to  change  the  present  method  by  which  only  a  small  portion  of  all 
immigrants  are  examined,  the  rest  being  "  inspected." 

(c)  The  Immigration  Act  should  provide  that  medical  officers 
of  the  Fnited  'States  Public  Health  Service  with  special  training 
in  the  diagnosis  of  mental  diseases  and  defects  should  be  detailed 
for  duty  in  sufficient  numbers  at  all  times  at  all  ports  of  entry. 
This  would  provide  definitely  by  law  for  a  procedure  which  now 
does  not  even  depend  upon  regulation. 

(d)  The  Immigration  Act  should  provide  that  such  medical 


REPORT  OF  SPECIAL  COMMISSIONER  81 

officers  at  all  times  have  tlio  necessary  facilities,  including  tin 
elusive  services  of  interpreters,  that  they  be  responsible  for  this 
part  of  the  medical  examination  and  be  required  to  make  recom- 
mendations, from  time  to  time,  as  to  facilities  .needed.  These 
provisions  have  been  shown  to  be  necessary  and  they  insure  the 
permanence  of  the  work. 

(e)  The  Immigration  Act  should  provide  for  the  imposition 
upon  transportation  companies  of  a  fine  of  not  less  than  $200  for 
bringing  to  this  country  any  alien  whose  insanity,  mental  defect, 
chronic  alcoholism  or  constitutional  psychopathic  inferiority  could 
have  been  detected  by  a  competent  medical  examination  prior  to 
his  embarkation. 

(f )  The  Immigration  Act  should  provide  for  a  special  study  of 
the  methods  employed  in  the  detection  of  mental  diseases  and  de- 
fects among  immigrants,  the  changes  desirable,  etc.,  by  a  board  of 
medical  experts,  including  officers  of  the  United  States  Public 
Health  Service  and  physicians  in  civil  life  who  are  especially 
familiar  with  the  subjects  involved. 

2.  DEPORTATION  BY  FEDERAL  WARRANT  OF  INSANE  ALIENS  WHO 
BECOME  PUBLIC  CHARGES  FROM  CAUSES  EXISTING  PRIOR 
TO  LANDING  OR  ARE  FOUND  IN  THE  STATE  IN  VIOLATION  OF 
THE  IMMIGRATION  ACT 

(a)  The  Immigration  Act  should  provide  that  when  the  chief 
executive  officer  of  a  public  institution  certifies  that  an  alien  is 
a  public  charge  therein,  it  shall  be  the  duty  of  the  proper  Immi- 
gration Commissioner  to  make  an  investigation  as  soon  as  possible 
to  verify  the  landing  of  such  alien  and  to  determine  if  he  is  de- 
portable. 

(b)  The  time  within  which  an  alien  may  be  deported  (three 
years  after  the  date  of  his  entry  into  the  United  States)  should 
be  extended  to  not  less  than  five  years,  so  that  the  period  shall  be 
at  least  as  long  as  that  within  which  an  alien  may  become  a  citizen. 

(c)  If  the  Immigration  Act  is  to  continue  to  embody  a  time  limit 
upon  deportation  it  should  further  provide  for  an  extension  of 
the  period  in  which  deportation  of  the  alien  may  be  effected,  when- 


82     ALIEN  INSANE  IN  CIVIL  HOSPITALS  OF  NEW  YORK  STATE 

ever  the  proceedings  for  deportation  are  commenced  within  the 
statutory  period.  At  present  delays  and  legal  stays  sometimes 
place  the  deportable  alien  safely  beyond  such  period. 

(d)  Logically  considered,  to  secure  the  deportation  from  this 
country  of  an  insane  alien,  the  Immigration  Act  should  require 
the  proof  of  but  two  facts,  viz :  insanity  and  foreign  citizenship. 
Neither  the  causation  of  the  alien's  insanity  nor  his  financial 
ability  should  enter  into  the  question.    From  every  point  of  view, 
however,  the  present  law  should  be  changed  so  as  to  provide  that 
an  alien  shall  be  deportable  unless  it  is  affirmatively  shown  that 
the  causes  of  the  alien's  insanity  arose  subsequent  to  landing. 
This  would  change  the  burden  of  proof  which  it  is  manifestly 
unfair  to  impose  upon  the  State. 

(e)  The  Immigration  Act  should  provide,  definitely,  for  the 
reimbursement  by  the  United  States  to  the  State  of  the  cost  of  the 
care  and  maintenance  of  deportable  aliens  from  the  date  of  ad- 
mission to  a  hospital  for  the  insane  to  the  date  of  deportation,  or 
until  the  date  of  discharge  or  death  in  the  case  of  an  alien  who 
for  any  cause  it  is  found  impossible  or  deemed  inadvisable  to 
deport. 

(f)  The  Immigration  Act  should  make  it  mandatory  that  the 
immigration  authorities   direct  that  the  insane  alien  who  is  to 
be  deported  shall  be  accompanied  to  his  final  destination  by  a 
suitable  attendant  in  each  case  in  which  it  is  certified,  by  a  medi- 
cal offijcer  of  the  United  States  Public  Health  Service,  or  by  the 
chief  medical  officer  of  the  institution  in  which  such  alien  has 
been  under  treatment,  that  the  alien's  condition  requires  special 
care  and  attendance.     The  expenses  of  the  attendant  both  going 
and  returning  should  be  borne  by  the  transportation  company. 

(g)  Even  if  "  Decision  No.  120  "  is  annulled  by  the  Federal 
authorities,  Congress  should  enact  a  law  providing  that  the  testi- 
mony of  competent  alienists  as  to  the  mental  condition  of  the  alien 
be  taken  as  sufficient  authority  for  the  issuance  of  a  Federal  war- 
rant of  deportation,  if  other  conditions  admit. 


REPORT  OF  SPECIAL  COMMISSIONER  83 

3.  REPATRIATION  OF  ALIENS  AT  EXPENSE  OF  STATE  OR  FRIENDS 
AND  WITH  CONSENT  OF  ALIENS  THEMSELVES 

(a)  The  Immigration  Act  should  provide  that  it  shall  be  a  mis- 
demeanor, punishable  by  a  fine,  for  any  transportation  company  to 
refuse  to  sell  tickets  for  or  to  receive  on  board,  guard  safely  and 
return  any  insane  alien  who  is  or  has  been  in  an  institution  for 
the  insane  and  who  desires  to  be  carried  to  the  country  of  which 
he  is  a  citizen;  provided  (1)  that  all  the  expenses  of  the  return 
of  such  alien  at  customary  rates,  be  borne  by  such  alien,  his 
friends  or  the  authorities  charged  with  his  care;  (2)  that  it  be 
certified  by  the  chief  'medical  officer  of  such  institution  for  the 
insane  that  such  alien  is  in  condition  to  travel  with  safety  to 
others;  (3)  that  it  be  certified  by  the  same  official  that  such  alien 
is  in  condition  to  travel  alone  with  safety  to  himself  or  is  pro- 
vided with  a  suitable  attendant;  and  (4)  that  such  alien  is  free 
from  any  quarantinable  disease. 

4.  APPROPRIATIONS 

Congress  should  make  adequate  appropriations  to  carry  into 
effect  the  foregoing  recommendations  for  the  exclusion  and 
deportation  of  insane  and  mentally  defective  aliens  and  to  that  end 
should  make  provision  for  the  requisite  number  of  trained  alienists 
and  interpreters  to  conduct  mental  examinations  at  the  various 
ports  of  entry ;  should  supply  all  needed  facilities  including  suffi- 
cient quarters  for  detention  for  the  purposes  of  observation  of  all 
immigrants  whose  right  of  entry  is  questioned ;  should  furnish 
funds  to  reimburse  the  States  for  the  cost  of  the  care  and  mainte- 
nance of  the  deportable  alien  insane;  and  should  supply  special 
care  and  attendance  for  insane  aliens  who  are  being  deported, 
whenever  the  necessity  therefor  is  certified. 

In  view  of  the  large  sums  of  money  received  each  year  by  the 
Federal  government  from  the  head  tax  on  immigrants  and  having 
in  mind  the  responsibilities  which  it  has  assumed  in  the  admission 
and  deportation  of  aliens,  simple  justice  requires  that  the  United 
States  appropriate  sufficient  monies  each  year  to  insure  the  ade- 
quate discharge  of  the  duties  and  obligations  arising  therefrom. 


84     ALIEN  INSANE  IN  CIVIL  HOSPITALS  OF  NEW  YORK  STATE 

5.   TJIE  PROPER  METHOD  OF  RETURNING  THE  ALIEN  INSANE  TO 

THEIR  HOMES 

There  should  be  a  centralized  and  uniform  system  for  returning 

*-•  O 

the  alien  insane,  operated  by  the  Federal  government,  with  such 
assistance  as  the  State  authorities  can  render.  The  present  dual 
system  by  which  we  return  these  aliens  —  deportation  by  the 
United  States  under  Federal  law  and  repatriation  by  the  several 
states  under  little  apparent  law  but  only  by  and  with  the  consent 
of  the  aliens  —  is  outworn  and  an  anomaly.  Over  the  admission 
of  aliens  the  Federal  government  now  exercises  sole  power.  Logi- 
cally and  rightly  therefore  it  alone  should  undertake  the  burden 
and  duty  of  caring  for  or  sending  from  this  country  such  of  them 
as  become  incapacitated  by  reason  of  insanity.  A  unified  and  ade- 
quate system  is  as  necessary  in  the  removal  of  aliens  as  in  the 
examination  of  immigrants,  the  one  being  the  corollary  of  the 
other.  These  are  distinctly  Federal  functions  and  should  be  ex- 
ercised by  the  general  government  for  the  benefit  of  all  the  states, 
The  United  States  is  clothed  with  authority  to  deal  with  foreign 
governments  in  matters  pertaining  to  their  respective  subjects 
while  the  several  states  have  no  powers  in  the  premises.  The 
Federal  government  may  control  common  carriers  of  immigrants ; 
the  states  may  not,  unless  perhaps  to  a  limited  degree. 

Two  of  the  practical  difficulties  in  the  way  of  the  adoption  of 
this  plan  are: 

First.  The  freedom  of  the  Federal  government  from  the  finan- 
cial burden  of  the  care  and  maintenance  of  the  alien  insane.  So 
long  as  this  continues  it  will  feel  little  incentive  to  assist  the 
states  in  removing  the  cause. 

Second.  The  large  number  of  insane  aliens  now  in  our  institu- 
tions who  cannot  be  deported  under  Federal  law  and  who  can  be 
returned  only  through  repatriation.  The  Federal  government 
should  not  be  heard  to  say  that  the  states  must  either  repatriate  or 
pay  for  the  care  and  maintenance  of  insane  aliens,  citizens  of 
none  of  the  states,  whom  it  will  not  deport.  This  is  arbitrary  and 
unjust. 

The  United  States  should  assume  the  entire  financial  burden  of 


REPORT  OF  SPECIAL  COMMISSIONER  S."> 

the  alien  insane  in  public  institutions  at  the  present  time  and  of 
those  who  may  hereafter  be  admitted  thereto.  When  this  is  don<j 
it  will  be  wholly  safe  and  advisable  to  entrust  to  the  Federal 
government  the  entire  discharge  of  the  duty  of  returning'  the  alien 
insane  to  the  countries  of  which  they  are  citizens. 
Respectfully  submitted, 

SPENCER  L.  DAWES 

Commissioner. 
January  23,  1914. 
LEWIS  R.  PARKER, 
CHARLES  A.  DOOLITTLE,  JR., 
Counsel. 


86     ALIEN  INSANE  IN  CIVIL  HOSPITALS  OF  NEW  YORK  STATE 


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Native-born  patients  
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Foreign-born  patients  
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104     ALIEN  INSANE  IN  CIVIL  HOSPITALS  OF  NEW  YORK  STATE 


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118     REPORT  OF  SPECIAL  COMMISSIONER  ON  ALIEN  INSANE 


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INDEX 


Page 

Acceptance  of  bonds 58 

Alien  and  nonresident  insane,  lack  of  sufficient  funds  for  return  of 59 

Alien  insane,  burden  of: 

improperly  placed  and  borne  unequally 47 

cost   of  caring  for 36 

proper  method  of  returning. 84 

Alienists,  Board  of: 

report  of  for  1911 61 

employment   of  at  Ellis  Island 78 

Alien  patients,  payments  of 39 

Aliens,  defined 22 

deported  and  repatriated  1905-1912 10 

in  1913 11 

deported  and  repatriated,  with  economic  savings  effected,  Chart  C...  12 

Aliens,  insane,  deportation  of,  by  Federal  warrant 75,  78,  81 

in  civil  State  hospitals 13 

repatriation    of 83 

time  in  United  States  before  admission 34,  35,  53 

All  admissions,  citizenship  of 24 

nativity    of 18,  19 

parentage   of 21,  22 

Amendments  proposed  to  Immigration  Law 80-3 

Appropriations  by  Congress  should  be  adequate 83 

Attendants  to  be  sent  with  deported  aliens 79 

Bonds,    acceptance   of 58 

Bureau  of  Deportation: 

duties  of  physicians  of 76 

expenditures    of 42,  43 

report  of,  for  1913 49 

work    of 10,  60,  61,  62 

work  of,  in  1913 13 

Cancellation  of  warrants  of  arrest  for  deportation 57 

Card  for  statistical  information 15 

Causation    of   insanity 54,  55 

' '  Causes  existing  prior  to  landing, ' '  provision  of  Immigration  Act  as  to . .  54 

Causes  of  existing  conditions 46 

Central  Islip  State  Hospital: 

aliens    in 14 

nativity  of  patients  in 14 

Chart  A,  Increase  of  patients  in  civil  hospitals  compared  with  increase 

in   expenditures 6 

Chart  B.  Increase  of  insane  patients  compared  with  increase  of  general 

population 8 

Chart  C.  Aliens  deported  and  repatriated  with  economic  savings  effected, 

1905-1912    12 

Chart  D.  Nativity,  parentage  and  citizenship  of  first  admissions,  1905-12  25 

Chart  E.  Nativity  of  insane  compared  with  nativity  of  general  population  28 

Chart  F.  Population  of  New  York  State  and  of  United  States  compared. .  31 
Citizenship: 

and  nativity  of  the  insane  in  the  State  hospitals 13 

definitions    22 

of   all   admissions 24 

Table    13 110 

of   first    admissions 22,  23 

Table    11 106 

of    readmissions 23,  24 

Table    12 108 

nativity  and  parentage  of  admissions 15 


120  INDEX. 

Page 

Civil  insane,  hospitals  for 4 

Classes  excluded  by  Immigration  Act 51 

Comparison  of  the  nativity  of  insane  and  of  general  population 26,  27,  29 

Comparisons    of    the    population    of    New    York    State    and    the    United 

States    30,  32 

Comptroller,  State,  appraisement  of  State  hospitals 4 

' « Control  Stations ' '  in  Germany 64 

Co-operation  between  Federal  and  State  officials 76 

Cost  of  caring  for  the  alien  insane 36 

Cost  of  maintenance: 

of  insane 4 

pending  deportation  on  warrant 49 

Cost  of  removal  of  an  insane  patient 43 

Cost,  per  capita: 

of   maintenance,    1905-1912 118 

of  patients  in  State  hospitals 40,  41 

Criminal  insane,  hospitals   for 4 

Dawes,  Dr.  Spencer  L.,  report  submitted  by 85 

"Decision    No.    120" 55,  56,  57,  58,  74,  79 

Definitions   : 22 

Deportation: 

by  a  centralized  and  uniform  system 84 

by  federal   warrant 75,  78,  81 

cancellation   of   warrants   of   arrest   for 57 

of  insane  aliens 59 

time  limit  on 52 

Dix,  Governor  John  A.,  study  made  by  direction  of 3 

Doolittle,  Charles  A.,  Jr.,  counsel 85 

Environment,  new  of  immigrant 68 

Eugenics: 

defined    71 

effects     71 

Exclusion  of  insane  and  mentally  defective  at  time  of  arrival 75,  78,  80 

Expenditures  of  State  hospitals: 

1900-12    5 

increase  of,  compared  with  increase  of  patients,  Chart  A 6 

Expenditures  of  State  for  alien  patients 40 

First  admissions: 

citizenship    of 22,  23 

nativity    of 16,  17 

parentage  of 19,  20 

Foreign-born  patients  in  the  civil  State  hospitals 13 

Funds,  lack  of  sufficient,  for  return  of  alien  and  nonresident  insane 59 

General  population,  parentage  of  insane  compared  with 27,  28 

Germany,  examination  of  immigrants  in 64 

Glynn,  Governor  Martin  H.,  report  to 3 

Great  Britain,   examination   of   immigrants  in 64 

Hamburg,  examination  of  immigrants  at 64 

Head  tax 50,  83 

Hospitals,  State  (See  State  hospitals). 
Immigrants: 

examination  of,  by  steamship  companies , 63,  64 

inadequacy  of  means  for  detecting  insanity  of,  at  ports  of  debarkation  66 

new,  environment  of 68 

exclusion  of  insane  and  mentally  defective 78 

Immigration    Act 46,  47,  48,  50 

defect  of,  as  to  classes  excluded 51 

defect  of,  as  to  ' '  Public  Charges " 54 

fine   imposed   by 65 

provisions  of,  as  to  causes  existing  prior  to  landing 54 


INDEX  121 

Immigration,  general:  Page 

problem   not  in   scope   of  inquiry 4 

rate    of    67 

regulation   of    46 

Immigration  fund   •. 48 

Immigration  Law,  amendments  to  proposed 80.  83 

Immigration    rules 49,  58 

Increase  of  insane  patients  compared  with  increase  in  general  population.  7 

Chart  B 8 

Inheritance  of  insanity 72 

Insane  aliens,  deportation  by  Federal  warrant 75,  78,  81 

Insane  and  mentally  defective,  exclusion  of 75,  78,  80 

Insane,  civil: 

hospitals   for 4 

criminal,    hospitals    for 4 

maintenance  of,  in  State  of  New  York 4 

ratio  to  general  population 9 

Insane  patients: 

increase  of,  compared  with  increase  of  general  population 7 

Chart  B • 8 

Insanity:1 

causation  of   55 

rate    of   in    cities 69 

Interpreters,  employment  of,  at  Ellis  Island 78 

Investigation,    outline   of 3 

Italy,  examination  of  immigrants  in 64 

Maintenance  of  patients,  annual  per  capita  cost  of,  in  New  York  State 

hospitals,  1905-1912,  Table  17 118 

Manhattan  State  Hospital: 

aliens  in    14 

nativity  of  patients  in 14 

Medical  officers  at  Ellis  Island 74 

Native-born  patients  in  civil  State  hospitals 13 

Nativity  and  citizenship  of  patients  in  State  hospitals: 

Table  1    86 

of  the  insane  in  the  State  hospitals 13 

Nativity  and  parentage  of  the  insane  and  of  the  population  of  the  State.  25 
Nativity: 

of  all  admissions 18,  19 

Table  4    92 

of  first  admissions,  Table  2 86 

1905-12 .16,  17 

of  insane,  compared  with  general  population 26 

of  readmissions,  Table  3 17,  18,  90 

Nativity,   parentage    and   insanity   in    New   York   State    and   the   United 

States  30 

Nativity,  parentage  and  citizenship: 

of  admissions  to  the  State  hospitals 15 

of  first  admissions,  Chart  D 25 

Naturalized  patients  in  the  civil  State  hospitals 13 

New  York  State  hospitals  for  the  insane 4 

Nonresidents  returned,   1905-1912 10 

1913     11 

Parentage: 

of  insane   compared   with  parentage   of  general  white  population   of 

State    27,  28 

of    all     admissions,     native,     foreign     and     unascertained     combined, 

Table  10    104 

of    all    admissions    to    the    State    hospitals    for    the    insane,    1905- 

1912    21,  22,  102 

of  first  admissions 19,  20 

Table  5   .  94 


122  INDEX 

Parentage  —  Continued:  Page 

Table  6    96 

of   readmissions    20,  21 

Table  7   98 

of  readmissions,  native,  foreign  and  unascertained,  combined,  Table  8,  100 

Parentage,  nativity  and  citizenship  of  admissions 15 

Parker,  Lewis  B.,  counsel 85 

Patients,  insane: 

increase  of,  compared  with  increase  in  expenditures,  Chart  A 6 

increase  of,  compared  with  increase  in  general  population 7 

in  State  hospitals 5 

Paying  and  nonpaying  patients  classified  according  to  citizenship 37,  38 

Payments  of  Federal  government  to  New  York  State  for  maintenance  of 

insane  aliens 50 

Payment  for  maintenance  of  insane  aliens 79 

Personal  property  of  civil  hospitals,  value  of 5 

Physicians   on   ships  bearing  immigrants 74 

Pollock,  Dr.  Horatio  M.,  statistics  prepared  by 13 

Population,  general: 

increase  of  compared  with  increase  of  insane  patients 7 

Chart    B 8 

nativity  of  insane  compared  with  nativity  of 26 

ratio  of  insane  to 9 

Population  of  New  York  State  and  of  United  States  compared,  Chart  F.  .  31 

with  respect  to  nativity,  parentage  and  insanity 30,  31 

Provision  for  and  cost  of  maintenance  of  insane  in  the  State  of  New  York  4 

Psychoses,  prevalent    70 

' '  Public  Charges, ' '  defect  of  Immigration  Act  as  to 54 

Public    hearings    ; . 

Bate  of  insanity  in  cities 69 

Batio  of  insane  to  general  population 9 

Beadmissions: 

citizenship    of     23,  24 

nativity  of 17,  18 

parentage    of    , 20,  21 

Beal  estate  of  civil  hospitals,  value  of 5 

Becommendations : 

for  action  by  the  United  States  government 78 

under  existing  laws 78 

new  legislation    80 

for  the  State  of  New  York , 75 

Bepatriation  of  insane  aliens 60,  76,  83 

Beport,  basis   of 3 

Besidence,  average  hospital 41 

Beturn  of  nonresidents   76 

Saving  to  State  from  removal  of  alien  and  nonresident  insane 44,  45 

Sex  of  patient  population 14 

State  Board  of  Alienists,  see  Bureau  of  Deportation. 

State  hospitals,  aliens  in 13 

State  Hospital  Commission,  arrangement  with  steamship  companies 62 

State  hospitals: 

expenditures  of   5 

foreign -born    patients    in 

native-born  patients  in 

nativity  and  citizenship  of  insane  in 13 

naturalized  patients  in 14 

valuation   of    4,  5 

State,  relation  of  to  United  States 46 

States: 

attitude   of   other 72 

deportation  from  other 73 

Statistical  card   .                                      15 


INDEX 

Page 

Statistical  research,  extension  of  facilities  for,  recommended 77 

Statistical  tables    87,  118 

' '  Statistics  of  the  Insane, ' '  for  1912 69 

Steamship  companies: 

arrangment  with   State  Hospital  Commission 62 

difficulties  with,  in  repatriating  aliens 62 

examination  of  immigrants  by 63,  64 

to  be  made  responsible  for  mental  condition  of  immigrants 74 

when  guilty   of   misdemeanor 63 

Suggestions  received    73 

Superintendents  of  State  hospitals,  duties  of,  with  respect  to  admissions.  .  76 

Summary  of  costs  and  expenditures  for  1912 42 

Summary    of    saving    to    State    from    removal    of    alien    and    nonresident 

insane    44,  45 

Suspension  of  rule  relating  to  maintenance 50 

Table  1.  Nativity    and    citizenship    of   patients    in    the    New   York    State 

hospitals,   September   30,    1912 86 

Table  2.  Nativity    of    first    admissions    to    the    State    hospitals    for    the 

insane,   1905-1912    88 

Table  3.  Nativity  of  readmissions  to  the  State  hospitals  for  the  insane, 

1905-1912     .' 90 

Table  4.  Nativity  of  all  admissions  to  the  State  hospitals  for  the  insane, 

1905-1912     92 

Table  5.  Parentage    of    first    admissions    to    the    State    hospitals    for    the 

insane,   1905-1912    94 

Table  6.  Parentage    of    first    admissions    to    the    State    hospitals    for    the 

insane,  native,  foreign  and  unascertained,  combined 96 

Table  7.  Parentage  of  readmissions  to  the  State  hospitals  for  the  insane, 

1905-1912     98 

Table  8.  Parentage  of  readmissions  to  the  State  hospitals  for  the  insane, 

1905-1912;   native,  foreign  and  unascertained  combined 100 

Table  9.  Parentage  of  all  admissions  to  the  State  hospitals  for  the  insane, 

1905-1912     102 

Table  10.  Parentage  of  all  admissions  to  the  State  hospitals  for  the  in- 
sane, 1905-1912;  native,  foreign  and  unascertained  combined 104 

Table  11.  Citizenship    of   first    admission    to    the    State    hospitals    for   the 

insane,   1905-1912    106 

Table  12.  Citizenship  of  readmissions  to  the  State  hospitals  for  the  insane, 

1905-1912     108 

Table  13.  Citizenship    of   all    admissions    to    the    State    hospitals    for    the 

insane,   1905-1912 .  . : 110 

Table  14.  Time  in  United  States  before  admission  of  aliens  and  patients 

whose  citizenship  is  unascertained;   first  admissions,   1905-1912 112 

Table  15.  Time  in  United  States  before  readmission  of  aliens  and  patients 

whose  citizenship  is  unascertained;   readmissions,  1905-1912 114 

Table  16.  Time  in  United  States  before  admission  of  aliens  and  patients 

whose  citizenship  is  unascertained;   all  admissions,   1905-1912 116 

Table  17.  Annual  per  capita  cost  of  maintenance  of  patients  in  New  York 

State  hospitals,  1905-1912    118 

Three-year   limit,   inadequacy   of 53 

Time   in    United   States   before   admission    of   aliens    and   patients   whose 
citizenship  is  unascertained: 

all  admissions,   1905-1912,  Table  16 116 

first  admissions,   Table   14 112 

readmissions,   1905-1912,   Table   15 114 

Time  limit  on  deportation 52 

Time  of  aliens  in  United  States  before  admission 34,  35 

United  States  should  assume  entire  financial  burden  of  the  alien  insane,  84,  85 

Valuation   of  State  hospital  plants 4,  5 

Warrants  of  arrest  for  deportation,  cancellation  of 57 

Warrants   of   deportation 79 

Williams,  Hon.  William,  address  of 66 


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